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• Published: 14 December 2021

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

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

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

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

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

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

Conclusions

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

Introduction

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

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

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

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

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

Participants

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

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

Study outcome

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

Primary exposure

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

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

Statistical analyses

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

Prevalence of bullying at school and mental health problems

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

Associations between bullying at school and mental health problems

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

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

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

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

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

Strengths and limitations

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

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

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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Acknowledgements

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

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

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Additional file 1..

Principal factor analysis description.

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

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Bullying is a public health issue that persists and occurs across several contexts. In this narrative review, we highlight issues and challenges in addressing bullying prevention. Specifically, we discuss issues related to defining, measuring, and screening for bullying. These include discrepancies in the interpretation and measurement of power imbalance, repetition of behavior, and perceptions of the reporter. The contexts of bullying, both within and outside of the school setting (including the online environment), are raised as an important issue relevant for identification and prevention. The role of medical professionals in screening for bullying is also noted. Prevention and intervention approaches are reviewed, and we highlight the need and evidence for social architectural interventions that involve multiple stakeholders, including parents, in these efforts. Areas in need are identified, such as understanding and intervening in cyberbullying, working more specifically with perpetrators as a heterogeneous group, and providing more intensive interventions for the most vulnerable youth who remain at risk despite universal prevention efforts.

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How Bullying Harms the Brain

Research pinpoints the brain-damaging force of bullying..

Posted June 17, 2023 | Reviewed by Hara Estroff Marano

• How to Handle Bullying
• Find counselling to support kids or teens
• Bullying is seen as a moral issue, but a meta-analysis of research shows it's a medical issue.
• Bullying, along with child maltreatment, can do physical damage to important brain regions.
• The physical harm bullying does to the brain shows up in poor academic performance and mental illness.

Two researchers have found that bullying damages a number of brain regions in children. The damage is such that victims fail to understand social cues, fail to think clearly, and fail to have a handle on their own behaviour and emotions. It’s devastating.

Researchers Iryna Palamarchuk and Tracy Vaillancourt conducted a meta-analysis of studies, including their own studies, on the impact of bullying victimization on the developing brains of children. Although they focused on the amygdala, fusiform gyrus, insula, striatum, and prefrontal cortex, they acknowledge that the negative effects of bullying are not limited to such areas of the brain. They explain that neurological interplay between the regions "contributes to the sensitivity toward facial expressions, poor cognitive reasoning, and distress that affect behavioral modulation and emotion regulation ."

In other words, when damage occurs to these brain regions, the victim may misinterpret or overreact to someone’s facial expressions. While a person may show surprise, the victim’s brain, harmed by bullying, may read the facial expression as angry or threatening. The brain regions malfunction. in a sense, because of bullying.

Victims may also struggle to use their rational mind to problem-solve or make decisions. Their cognition , the ability to think through challenges and problems, is impaired by bullying. Furthermore, their distressed brain may struggle to self-regulate or modulate their conduct. Likewise, their bullied brain may struggle to manage emotional outbursts or withdrawals.

What’s makes these injuries to the brain even more distressing is that they are invisible to the naked eye and thus most in society do not even know they have occurred. Victims know they are struggling, but few would be informed that it’s because a series of regions in their brain have been harmed. Most concerning: if we do not know the brain is hurt, we do not set in motion the care needed for the brain to repair and recover. This is tragic because in fact the brain is innately wired to heal with evidence-based interventions.

How do children react who are victimized by bullying?

One manifestation discussed by Palamarchuk and Vaillancourt focuses on the way in which brain responses that naturally protect the target are thrown out of whack by the repeat nature of most bullying. Withdrawal, for instance, is an effective way the brain responds to threat out in the world, but if bullying behaviour happens repeatedly, this normally healthy brain response tilts into unhealthy territory.

The way bullying harms brain regions can lead to “the development of mental health problems including anxiety , depression , psychosis , psychosomatic and eating disorders among bullied children.” Some children may develop emotional numbing, associated with further harm to the brain, seen in post- traumatic - stress disorder ( PTSD ).

It is well-established and frequently discussed in educational and parental circles that children targeted by bullying often see a drop in their grades. What is missing, however, is the brain science that informs us that poor academic performance is likely a result of “neurophysiological changes like the ones found in maltreated children.”

What kind of physical brain changes do researchers document in maltreated and bullied brains?

Children who are abused by adults or bullied by peers may show signs of “suppressed neurogenesis, stress-associated delayed myelination, as well as distorted apoptosis.” Scientists know that our brains produce new cells throughout our lifespan. When a brain is being abused or bullied, brain-imaging reveals, the birth of new brain cells, or neurogenesis, is compromised and in some cases halted.

Scientists know that myelination is the way the brain creates efficient, rapid, superhighways of information transmission in the brain. Myelin is a fatty insulator that wraps around axons and allow the brain to wire-in skills and knowledge through repeated practice and dedication to achievement. Children who are being maltreated or bullied suffer from delays in the critical process of laying down the myelin that helps people capitalize on their talents.

Moreover, among the bullied and abused, a normal process of apoptosis, or cell death, is “elevated.” The cycle of cell birth and cell death is put into a state of imbalance. The target’s brain struggles to birth new cells while at the same time an elevated number of cells are dying. As a result, targets suffer anxiety, depression, PTSD, poor academic performance and yet rarely know that their brain is unwell and needs help.

Chances are very good that those who abuse and bully do not know that the way they act is causing damage to a child’s brain.

It is time to educate everyone about the seriously harmful impact of bullying on the brain

As Palamarchuk and Vaillancourt demonstrate in their own studies, and in the meta-analyses they undertake into extensive research being conducted internationally, child maltreatment and peer bullying harm regions of the brain in very serious and lasting ways. This knowledge needs to be shared with all adults who are in positions of trust and authority over children.

Parents, teachers, coaches, doctors, social workers, mental health professionals need to use every opportunity to help children understand that the epidemic of mental illness in youth populations could be lessened if it were widely known that all forms of child maltreatment and bullying do damage to regions in the brain. Physical bullying may visibly harm the brain, but far more insidious is emotional, psychological, social-relational, and cyberbullying, as the damage they do to the brain is unseen. Emotional neglect, ignoring, ostracizing also does deadly harm, but cannot be seen.

Where the damage can be seen and documented is in brain imaging. The knowledge researchers have grained through noninvasive technology establishes that bullying can no longer be understood merely as a moral issue. It must be understood as a medical crisis as serious as catching a potentially fatal virus.

There need to be public service announcements about the devastating invisible neurological scars bullying and child maltreatment leave on the brain. The damage can be seen on brain scans. Even more important, the damage can be repaired once acknowledged and identified.

I. Palamarchuk & T. Vaillancourt. (2022). “Integrative Brain Dynamics in Childhood Bullying Victimization.” 2022 Frontiers in Integrative Neuroscience 16:1-24.

Jennifer Fraser, Ph.D., is an award-winning educator and bestselling author. Her latest book, The Bullied Brain: Heal Your Scars and Restore Your Health , hit shelves and airwaves in April 2022.

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Prevention and Intervention: Multi-Tiered Approaches to Bullying

What is multi-tiered systems of support.

The Multi-tiered Systems of Support (MTSS) framework includes school-based interventions or services that address different “levels” of supports needed to deal with the range of learning, mental health, and emotional-behavioral health concerns that a student may have. It is also used in bullying prevention and intervention. Multi-tiered service delivery involves providing universal and selective prevention services, as well as indicated intervention services.

How does MTSS Work to Prevent Bullying?

Universal prevention.

Universal bullying prevention efforts, the first tier in the MTSS model, are designed to reduce risk and increase resilience for specific populations within a school community. These prevention strategies reach all students, regardless of their risk; and benefit the whole school community. Some of the most effective bullying prevention efforts work to improve the overall social and emotional climate of a school, and foster positive social or inclusive behavior among all students. Another prevention tactic schools can take is to hold classroom meetings that reinforce positive behavior expectations and provide guidance on how to respond to bullying. Services are designed to address student needs and academic challenges, and they are often supported by state or national educational initiatives (e.g., bully prevention curricula, positive behavioral intervention supports [PBIS], social emotional learning [SEL] ).

Research shows that both students and educators benefit from bullying prevention efforts. Results from a comprehensive and systematic review of research on the effectiveness of school-based programs to reduce bullying show that they effectively reduce bullying by 20 to 23 percent and victimization by 17 to 20 percent.

Selective Prevention

The second tier in MTSS is an additional layer of support, where school staff delivers selective prevention and intervention services to youth who may have greater needs than those of the general student body who receive universal services. Selective interventions often focus on youth who are at higher risk of engaging in bullying or students who are at-risk for being the target of bullying. For youth who bully others, selective prevention may include reinforcing consequences for bullying, and using teacher or counselor mediation to deal with interpersonal conflict. To reduce the social benefits related to bullying, students may be encouraged to defend classmates who are the targets of bullying. For youth at-risk of being bullied, selective services may include assertiveness training and developing peer support groups.

There is growing empirical support for use of peer support groups and active bystander training for students who disrupt bullying incidents. One study found that peer and teacher support buffers against the negative impact of being bullied. Another study found that teacher support was associated with decreases in student-reported bullying. Several other studies suggest that preparing students to be active bystanders is one of the most effective ways to prevent or stop bullying when it is occurring.

How is MTSS used for effective intervention?

MTSS is effective for bullying intervention when youth with various academic, behavioral, and health needs are involved. The components of most MTSS intervention models include:

• Use of universal screening
• Early intervention service delivery
• Collaborative problem solving
• Progress monitoring
• Application of intervention services across different levels of intensity

Indicated Interventions

The third tier of multi-tiered service delivery involves implementing indicated interventions to students whose needs are not adequately addressed by the previous two tiers of service delivery. When third-tier interventions are provided, supports are more intense and tailored to specific needs, usually for a small number of students. These interventions often address mental health concerns, behavior issues, and academic performance. These may involve working with administrators, multiple teachers, school resource officers, family members, and others who have a strong impact on a student’s life. For example, a school-based mental health professional might use trauma-focused cognitive-behavioral therapy (CBT) – a type of mental health intervention used to reduce symptoms related to violence exposure – to help a student with emotional or behavioral concerns while coordinating with other school personnel to provide other academic and social supports. Although research on the specific use of indicated interventions for bullying is still emerging, a considerable body of research supports the use of these interventions for related problems and concerns in school settings, such as conflict with peers. The MTSS model enables educators and mental health professionals to provide a range of services to students who display varying degrees of risk, with flexibility in how they address the specific needs of students to support them in achieving inclusion and success.

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Bullying and the Brain

• Published 30 Apr 2015
• Reviewed 30 Apr 2015
• Author Mary Bates
• Source BrainFacts/SfN

Brain research is revealing that bullying is more than just an unfortunate part of growing up. It can cause long-term changes to the brain that leads to cognitive and emotional deficits as serious as the harm done by child abuse.

Being bullied is a stressful experience. Victims of bullying often struggle with anxiety, depression , poor self-esteem, and drug abuse — during the bullying and well into adulthood.

It turns out that long-term changes to the brain may be behind these behavioral issues. Bullying can leave a lasting mark on the developing brain, and brain science is starting to show how devastating and persistent the scars of bullying can be.

Stressed Out

Bullying can alter levels of stress hormones, and research in animals and people shows how this can affect brain function.

Chronic stress in humans is a known risk factor for drug abuse, and scientists want to know if being a victim of bullying poses a similar risk. To study this, scientists like Klaus Miczek , a psychologist at Tufts University, model bullying in rodents, often by putting an older, more aggressive rat or mouse in the cage of a juvenile animal. The dominant animal pushes the younger one around, maybe even biting it to show it who’s boss.

Miczek has found that bullied animals have higher amounts of the stress hormone corticosterone in areas of the brain that process rewarding stimuli, like drugs of abuse. He also saw that too much of the hormone can remain in these brain areas long after the stress has ended, possibly leading to a propensity to abuse drugs. When given access to drugs like cocaine and alcohol , Miczek’s bullied rodents took more of the drugs than non-bullied animals, even months later when they were adults.

The most interesting aspect of this research, Miczek says, is how little social stress it takes to lead to a persistent, long-lasting effect. "In rats, it only requires four episodes of social stress, which are five minutes long each," he says. "And the effects of that are seen into adulthood."

Bullying can also alter stress hormones in humans. In a long-term study of teenagers, Tracy Vaillancourt , a psychologist at the University of Ottawa, found that bullied boys and girls have abnormal levels of cortisol compared to their non-bullied peers. Abnormal cortisol levels can weaken the immune system and can even kill nerve cells in the hippocampus , a brain region involved in memory. In fact, Vaillancourt has found that bullied teens perform more poorly on memory tests designed to examine hippocampal functioning compared to their non-bullied peers, suggesting that their abnormal cortisol levels might be affecting their brains.

Immune to Stress

Social stress also has a dramatic effect on immune system functioning, which in turn can negatively affect brain function.

When exposed to stress, our bodies produce more white blood cells, which in turn produce and release more pro-inflammatory substances that normally function to help the body fight off infection. In the case of chronic stress, scientists think the body produces too many white blood cells, resulting in sustained production and release of pro-inflammatory substances.

"When you experience chronic social stress, you have the immune response, but it doesn't turn off properly," says Scott Russo , a neuroscientist at the Icahn School of Medicine at Mount Sinai. "The immune system ramps up and doesn't shut down, and that then causes damage such as nerve cell death. In vulnerable individuals, these changes can last for months following the stress."

However, Russo found that some animals are resilient in the face of social stress. When exposed to an aggressive adult, these individuals had fewer white blood cells and pro-inflammatory substances. Russo thinks there is some mechanism by which resilient individuals dampen negative inflammatory responses to stress.

To illustrate the connection between the immune system and behavioral resilience, Russo and his colleagues took immune system cells from resilient mice and injected them into stressed mice. They found that, following the injections, stressed mice showed less social avoidance and anhedonia, the inability to feel pleasure. In effect, the stressed animals received the benefits of the resilient animal's immune system.

The results show that social stress can lead to a heightened immune response which, in turn, can lead to changes in behavior. Russo’s research suggests that dysregulation of the immune system, like that linked to chronic social stress, can lead to psychiatric disorders , such as depression and anxiety.

A Vicious Circle

Not only do victims of bullying experience heightened stress and immune responses, but research in animals suggests that they might also be more likely to become bullies themselves.

Researchers at the University of Texas at Austin studied social stress in hamsters and found that juvenile hamsters who were bullied by an adult became more aggressive toward smaller animals, while being fearful and subordinate with hamsters of similar size or larger.

"Basically, a bully victim becomes a victimizer," says Yvon Delville , who led the study.

Delville also examined the hamsters' brains and found that socially-stressed hamsters showed changes in the levels of the neurotransmitters vasopressin and serotonin. In people, high levels of vasopressin are associated with increased aggression, while serotonin is known to inhibit aggression.

Bullied hamsters had lower levels of vasopressin and higher levels of serotonin than their non-bullied littermates. Delville is currently determining how these changes in neurotransmitter levels lead to enhanced aggression, and he suspects the aggression is secondary to changes in brain areas that govern more general features of behavior, such as impulse control.

Delville's results suggest adolescence may be a sensitive period for the development of aggressive behavior in adulthood, with chronic social stress making it more likely that victims will become bullies themselves. He says his results support what is often observed in humans: where you have violence against children, you'll find children becoming violent.

"People argue that bullying is a rite of passage or it builds character, but that idea is so misguided," Vaillancourt says. "Our work supports the idea that bullying is actually a seriously harmful event in a child's life. It's a public health issue, because it affects so many children adversely and the biological evidence supports that it confers a risk for future health problems."

Not all bullied kids have long-term damage to their brains or changes in their behavior, but those who do may carry these neurological scars for a lifetime. Brain research is helping to recast bullying as a serious form of childhood trauma with the potential to cause long-term chemical and structural damage to the brain.

About the Author

Mary Bates is a freelance science writer interested in the brains and behavior of humans and other animals. For her graduate degree in psychology, she studied the echolocation abilities of big brown bats. She has written for Psychology Today, Scientific American's Mind Matters blog, the Howard Hughes Medical Institute, and other print and online publications.

CONTENT PROVIDED BY

BrainFacts/SfN

Burke AR, Miczek KA. Stress in adolescence and drugs of abuse in rodent models: role of dopamine, CRF, and HPA axis. Pschopharmacology 231(8): 1557-1580 (2014).

Christoffel DJ, Golden SA, Russo SJ. Structural and synaptic plasticity in stress-related disorders. Nature Reviews Neuroscience. 22(5): 535-549 (2011).

Delville Y, Melloni RH Jr., Ferris CF. Behavioral and neurobiological consequences of social subjugation during puberty in golden hamsters. The Journal of Neuroscience. 18: 2667-2672 (1998).

Norman KJ, Seiden JA, Klickstein JA, Han X, Hwa LS, et al. Social stress and escalated drug self-administration in mice I. Alcohol and corticosterone. Psychopharmacology. 232(6): 991-1001 (2015).

Russo SJ, Murrough J, Han MH, Charney DS, Nestler EJ. Neurobiology of resilience. Nature Neuroscience. 15(11): 1475-1484 (2012).

Vaillancourt T, Duku E, Becker S, Schmidt L, Nicol J, et al. Peer victimization, depressive symptoms, and high salivary cortisol predict poor memory in children. Brain and Cognition. 77: 191-199 (2011).

Vaillancourt T, Duku E, deCatanzaro D, MacMillan H, Muir C, et al. Variation in hypothalamic-pituitary-adrenal axis activity among bullied and non-bullied children. Aggressive Behavior. 34: 294-305 (2008).

Vaillancourt T, Hymel S, McDougall P. The biological underpinnings of peer victimization: Understanding why and how the effects of bullying can last a lifetime. Theory into Practice. 52: 241-248 (2013).

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124 Bullying Essay Topics

🏆 best essay topics on bullying, ✍️ bullying essay topics for college, 👍 good bullying research topics & essay examples, 🎓 most interesting bullying research titles, ❓ bullying research questions.

• School Bullying: Causes and Effects
• Bullying in Schools: Essay Example
• The Problem of Bullying in School
• Chronicles of Bullying: An Editorial Article
• Bullying at School and Impact on Mental Health
• Bullying in Schools: Anti-Bullying Programs
• School Bullying and Student’s Development
• Bullying: A Serious Social Problem Bullying is undesirable behavior that society must deter at all costs. In schools, teachers, parents, and other stakeholders should have working knowledge on managing the vice.
• Bullying Behavior and Its Negative Effects on Children Bullying behavior is a severe issue among school-age children. This essay addresses the negative effects of bullying on children and the ways of overcoming the problem.
• Negative Bullying Outcomes: A Persuasive Speech Bullying has adverse effects on both victims and perpetrators. Bullying should be prevented, or should it occur, reported, and taken care of as soon as possible.
• Prevention of Bullying in Schools School bullying is a relevant and critical global issue, and while it affects all children, some groups may experience various disparities and increased exposure to bullying.
• Bullying Effects on Health and Life Quality When children are subject to bullying by their peers, it affects their feelings and evokes negative emotions in the first place.
• Workplace Bullying and Its Implications on Organizations Discrimination is one of the major challenges that organizational leaders face within the workplace. Workplace bullying refers to any acts intended to intimidate a colleague.
• Teenagers’ Contemporary Issues: Bullying at School Bullying can be caused by differences between students, and the existing assessment and support options contribute to improving the situation.
• Online Bullying Takes Over the World In the context of a rapidly and highly digitized global environment, online bullying, otherwise known as cyberbullying, has become a prevalent issue.
• The Cognitive Behavioural Therapy on Victims of Bullying This paper will be able to ascertain that Cognitive Behavioural Therapy is a very effective therapy that defies the ugly trend of bullying in schools.
• Bullying and Sexual Harassment at Work Place According to Safety and Health Assessment and Research for Prevention, workplace bullying occurs when an individual direct irrational actions repeatedly towards their fellow worker.
• Bullying Problem in School Bullying is caused by genetic predisposition, relations with peers, and as a reaction to the situation in school or at home.
• Why Bullying Is Wrong and Methods of Resolving Disputes Without Violence Such methods of conflict resolution as mediation, communication, and listening may eliminate the harmful impact of such behavior without violence.
• The Issue of Cyber-Bullying in Education Field Bullying has been recognized as a pervasive and a severe problem as well as a significant concern, mostly in the educational field.
• Bullying and Parenting Styles There are many positive and negative outcomes of parenting on children. This paper aims at investigating the connection between several types of parenting and bullying behaviors.
• Reducing Bullying in Schools by Involving Stakeholders Schools should raise awareness among educators, instructors, and community members about their roles and responsibilities in the battle against bullying.
• School Bullying and Problems in Adult Life Bullying is aggressive behavior that can be seen in different children, teenagers, and adults. In this paper, the causes of bullying and the effects of it will be presented and discussed.
• Bullying and Work-Related Stress in the Irish Workplace One of the best analyses of relationships between workplace stress and bullying has been done in the research study called “Bullying and Work-Related Stress in the Irish Workplace.”
• Bullying in the Modern Society: Review Bullying is one of the major concerns of modern society. Following the statistics, about 40% of all individuals have experienced being bullied at least once.
• The Consequences of High School Bullying This annotated bibliography includes summaries of four academic studies that explore the effects of bullying on high school students.
• Cyber-Bullying and Ways to Solve the Problem The primary goal of the given study is the investigation of cyber-bullying, which is nowadays one of the integral parts of social media and the Internet.
• Bullying in Poverty and Child Development Context The aim of the present paper is to investigate how Bullying, as a factor associated with poverty, affects child development.
• Bullying Among Adolescents Problem Studying the problem of bullying, its factors of influence, and the application of developmental theories are critical for finding ways to combat it effectively.
• Bullying of Learners with Disabilities The problem of bullying remains one of the predicaments learners with disabilities encounter in their learning environments.
• Anti Bullying Prevention Program The standards for anti-bullying program aims to prevent not only the behavior of bullying but also behavior representing the full spectrum of inter-student cruelty.
• Workplace Bullying and Its Impact on People’s Mental Health Workplace bullying turns out to be a serious theme for discussion because of a variety of reasons, and one of them is its impact on people’s mental health.
• Fear Appeal in the Stop Bullying Public Campaign In the video “Stop bullying,” the subject matter is presented shockingly. The 47-second clip shows a high school girl receiving an aggressive text message from her peers.
• Organization Conflicts and Bullying Workplace bullying is a serious problem with huge costs attached to it in terms of loss of working days. The topic requires academic attention to ascertain the factors that induce such behavior.
• The Social Problem of Bullying and the School System The present paper focuses on the connection between the social problem of bullying and the school system, describing each of these concepts.
• The Problem of Workplace Bullying: Literature Review The purpose of this paper is to provide a review of the relevant literature on the topic of workplace bullying.
• Bullying and School Drop Out Rate Relationship Analysis Bullying is rife in schools where physical and verbal abuse occurs among pupils/students. There is “a close relationship between bullying, school involvement, and literacy”.
• Exploring Workplace Bullying in Nursing This paper critiques Etienne’s 2013 study of workplace bullying in nursing and highlights the strengths and weaknesses of the research.
• Causes of Bullying in Nursing The relationship between medical staff is an important aspect that determines the quality of work in a particular institution and the healthcare system as a whole.
• School Bullying and Legal Responsibility The following paper will discuss and cover the rate of school bullies’ legally unregulated actions and the detriment that they constantly cause to other children who surround them.
• Cyber-Bullying and Cyber-Stalking as Crimes Cyber-bullying and cyber-stalking are relatively close in meaning, but there is a slight difference in the definition of these terms.
• Harsher Laws for Cyber Bullying The number of people using social networks is growing but they do not see the danger in remote communication and are subjected to cyberbullying.
• Bullying: A Guide for the Parents The first way for parents to assist the kid in coming up with bullies is to teach them a set of responses, which they can use in case someone is picking on them.
• The Meaning of Cyber Bullying The work reveals the meaning and purpose of cyberbullying, what signs characterize it and the solution to cyberbullying.
• High School Bullying: Psychological Aspects The study discusses the psychology behind bullying, the effects of bullying on all the involved parties, and emergent patterns.
• The Workplace Bullying Prevention Policy The problem of bullying creates a severe issue for the atmosphere of the workplace environment, the mental health of workers, and their performance.
• The Issue of High School Bullying Bullying cases among high school students have been on the rise in modern society. High school bullying is mainly caused by media exposure.
• Bullying at Pre-School and Preventive Measures This paper provides five tips for pre-school bullying prevention, the first of which is to give opportunities for children to show kindness and respect.
• Bullying and Methods of Solving This Problem The article is devoted to the causes of bullying which develops in almost any closed community among children and adolescents.
• Bullying During Orientations in the Universities In order to address the issue related to bullying during orientations, only the most empathetic senior students should be allowed to participate in orientations.
• The Relation Between the Teen Suicide and Bullying During the teenage years, bullying and harassment represent cases of social animosity that make suicide an option.
• Cyber Bullying Messages in Communication Networks Bullying can come in different forms, but it always causes injury or even worse. Bullying victims may carry the psychological wounds of their ordeal for the rest of their life.
• Problem Scenario: Workplace Bullying in Teaching When the word “bullying” is used in the context of education, one often presumes the situation in which one student systematically mistreats another.
• Bullying and Patient Safety in Clinical Settings Besides damaging the atmosphere in clinical settings and negatively affecting the personnel, bullying can lower the quality of healthcare services and harm patient safety.
• The Long-Term Consequences of Being Bullied or Bullying Others in Childhood This study attempts to discuss the main consequences on the mental and physical health of victims, bully-victims, and bullies themselves, and comment on the prevalent patterns.
• Bullying as Managerial Issue in Nursing Sector Bullying is a significant nursing issue due to the negative impact caused on the performance level among the employees.
• Problem of Bullying Overview and Analysis Bullying can have harmful impacts on everyone involved, including bullies, the bullied, and bystanders. It can be prevented through the use of selective preventive programs.
• Nurse Bullying: Unprofessional Conduct Bullying can be exhibited in the form of physical and verbal threats, social seclusion, aggressive behaviors, and suppression of applicable care information.
• Bullying: A Concern for Modern Communities and Educational Establishments Parents can educate their children to create safe environment for healthy development, both physical and mental, guaranteeing the absence of abusive behavior or victimization.
• Bullying and Its Impact on My Life In this essay, the author talks about the impact of bullying on his life and how he managed to cope with the problem.
• “Nurse Exposure to Physical and Nonphysical Violence, Bullying…” by Spector This paper is a critique of the article titled “Nurse Exposure to Physical and Nonphysical Violence, Bullying, and Sexual Harassment: A Quantitative Review”.
• Anti-bullying Practices in Criminal Prosecution Anti-bullying practices have proceeded past only encouraging an individual to avoid ill-treatment of their peers to the establishment of laws.
• Workplace Bullying: Dealing With the Office Bully The psychological stress caused by bullying can be so severe that in the worst case, it can lead to depression and quitting.
• Deterring Juvenile Crime. Bullying and Delinquency Delinquency can be defined as a crime committed by a minor; in the recent few years, cases of juvenile delinquency have been on the rise.
• The Dumfries and Galloway Council’s Policy Against Bullying This paper discusses the analysis of the bullying in general and its understanding in the works of Dumfries and Galloway Council.
• Workplace Bullying in the Nursing Areas The paper is aimed to tell about the importance of overcoming workplace bullying in the example of a nursing collective.
• Bullying Among Nursing Staff The bullying in health care is still present, and health practitioners’ mental health, motivation, and ability to uphold precision and self-composure are compromised.
• Nurse Bullying and Legal Interventions Nurse bullying has to be addressed by healthcare establishments and national agencies to ensure proper work culture and adequate environment for patient care.
• Horizontal Violence and Bullying in Nursing There is a direct correlation between horizontal violence and job satisfaction among nurses, which affects the efforts of individuals who choose this profession.
• Parenting Style and Bullying Among Children The investigation of parenting styles is highly essential to understand how they affect the bullying behavior of children to prevent it.
• Bullying and Laws in American Schools Researchers distinguish two major kinds of bullying that take place in the academic setting: direct and indirect.
• Addressing Bullying in Elementary and Middle School Classrooms The study mainly focuses on teachers’ lack of knowledge on how to deal with the issue of bullying in the classroom in an effective manner.
• School Bullying and Teacher Professional Development
• Bullying and Its Effect on Our American Society
• Physical, Emotional, and Social Bullying
• The Government Should Put Laws in Place To Prevent Bullying
• Childhood Bullying and Social Relationships
• Bullying and Its Effects on Individual’s Education
• The Emotional and Physical Aspects of Bullying
• Bullying and Its Effects on the Person Who Is Being Hurt
• Childhood Bullying and Its Effects on Children
• Cyber Bullying Affects People‘s Lives More Than One Might Think
• Managing Bullying and Harassment in the Workplace
• Bullying Affects the Social Learning Theory
• How Has Bullying Changed Our Modern World?
• Bullying and the Workplace and Affect Morale
• The Bible Belt and Its Beliefs on the Problem of Bullying
• Cyber-bullying Through Anonymous Social Media
• The Difference Between Bullying and Harassment
• Racial Bullying and Its Effects on the Middle of the Twenty
• Bullying Among Children With Autism Spectrum Disorder
• Social Media Bullying and Cyberbullying
• Bullying Prevention and School Safety
• Physical and Verbal Bullying in Schools
• What Are Schools and Parents Doing for Bullying Prevention?
• What Are the Effects of Bullying in Public Schools?
• What Strategies Might You Employ to Encourage Pupils to Prevent Bullying?
• How to Talk to Your Children About Bullying?
• What Are the Six Types of Bullying Parents Should Know About?
• Which American State Has the Toughest Bullying Laws?
• Who Started and Invented Anti-Bullying Day?
• What Countries Have Anti-Bullying Laws?
• Which American State Is the Only One to Not Have an Anti-Bullying Law?
• What Is the Meaning of Anti-Bullying Law?
• What Is the Number One Determinant of Bullying Will Occur?
• When Was the First Anti-Bullying Law Passed?
• Is Bullying a Social Determinant of Health?
• What Should Be in an Anti-Bullying Policy?
• Why Is the Anti-Bullying Policy Important?
• Why Should We Be Aware of the Anti-Bullying Act of 2013?
• What Is the Meaning of Emotional Bullying?
• What Is the Punishment for Anti-Bullying Act?
• Is Bullying a Social Phenomena?
• Who Is the Father of Bullying Research?
• What Is a Good Slogan for Stop Bullying?
• Why Do the Bullying Programs not Work?
• Why Students Engage in Bullying?
• Why Are Workplace Bullying and Violence Important Issues for Organizations?
• Why Should Bullying Not Be Harsh?
• What Is the Most Important Strategy for Bullying Prevention?
• Why Do We Need to Conduct a Study About Bullying?
• Are Bullying Prevention Programs Effective?
• Who Should Universities Have the Ability to Punish Students for Cyber Bullying?
• Are Neoliberalist Behaviours Reflective of Bullying?

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• About Youth Violence
• Risk and Protective Factors
• School-Associated Violent Death Study
• Youth Violence Prevention Centers

About Bullying

• Bullying is a form of youth violence and an adverse childhood experience (ACE).
• Bullying is widespread in the U.S., but bullying is preventable.

What is bullying?

CDC defines bullying as 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. 1 Common types of bullying include:

• Physical such as hitting, kicking, and tripping.
• Verbal including name-calling and teasing.
• Relational or social such as spreading rumors and leaving out of the group.
• Damage to victim's property.

Bullying can also occur through technology, which is called electronic bullying or cyberbullying. 1 A young person can be a perpetrator, a victim, or both (also known as "bully/victim").

For more information about bullying definitions, please see Bullying Surveillance Among Youths: Uniform Definitions for Public Health and Recommended Data Elements, Version 1 .

Quick facts and stats

Bullying is widespread in the United States. Bullying negatively impacts all youth involved including those who are bullied, those who bully others, and those who witness bullying, known as bystanders.

• Bullying is common . About 1 in 5 high school students reported being bullied on school property. More than 1 in 6 high school students reported being bullied electronically in the last year. 2
• Some youth experience bullying more than others . Nearly 40% of high school students who identify as lesbian, gay, or bisexual and about 33% of those who were not sure of their sexual identity experienced bullying at school or electronically in the last year, compared to 22% of heterosexual high school students. About 30% of female high school students experienced bullying at school or electronically in the last year, compared to about 19% of males. Nearly 29% of white high school students experienced bullying at school or electronically in the last year compared to about 19% of Hispanic and 18% of Black high school students. 2
• Reports of bullying are highest in middle schools (28%) followed by high schools (16%), combined schools (12%), and primary schools (9%).
• Reports of cyberbullying are highest in middle schools (33%) followed by high schools (30%), combined schools (20%), and primary schools (5%). 3

Bullying can result in physical injury, social and emotional distress, self-harm, and even death. It also increases the risk for depression, anxiety, sleep difficulties, lower academic achievement, and dropping out of school. Youth who bully others are at increased risk for substance misuse, academic problems, and experiencing violence later in adolescence and adulthood. 4 Youth who bully others and are bullied themselves suffer the most serious consequences and are at greater risk for mental health and behavioral problems.

Bullying is preventable. There are many factors that may increase or decrease the risk for perpetrating or experiencing bullying. To prevent bullying, we must understand and address the factors that put people at risk for or protect them from violence . CDC developed, Youth Violence Prevention Resource for Action , to help communities take advantage of the best available evidence to prevent youth violence. 5 This resource is also available in Spanish and can be used as a tool in efforts to impact individual behaviors as well as the relationship, family, school, community, and societal risk and protective factors for violence. The approaches in this resource, particularly universal school-based programs that strengthen youths' skills and modify the physical and social environment, have been shown to reduce violence and bullying or key risk factors.

Different types of violence are connected and often share root causes. Bullying is linked to other forms of violence through shared risk and protective factors. Addressing and preventing one form of violence may have an impact on preventing other forms of violence.

• Gladden RM, Vivolo-Kantor AM, Hamburger ME, Lumpkin CD. Bullying surveillance among youths: Uniform definitions for public health and recommended data elements, Version 1.0. Atlanta, GA; National Center for Injury Prevention and Control, Centers for Disease Control and Prevention and U.S. Department of Education; 2013. Available from https://www.cdc.gov/violenceprevention/pdf/bullying-definitionsfinal-a.pdf.
• Centers for Disease Control and Prevention. Youth risk behavior surveillance—United States, 2019. Morbidity and Mortality Weekly Report–Surveillance Summaries 2020; 69(SS1). Available from https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2019/su6901-H.pdf
• Diliberti, M., Jackson, M., Correa, S., and Padgett, Z. (2019). Crime, Violence, Discipline, and Safety in U.S. Public Schools: Findings From the School Survey on Crime and Safety: 2017–18 (NCES 2019-061). U.S. Department of Education. Washington, DC: National Center for Education Statistics. Retrieved from http://nces.ed.gov/pubsearch
• Farrington D, Baldry A. Individual risk factors for school bullying. Journal of Aggression, Conflict and Peace Research 2010; 2(1):4-16. Available from https://doi.org/10.5042/jacpr.2010.0001.
• David-Ferdon, C., Vivolo-Kantor, A. M., Dahlberg, L. L., Marshall, K. J., Rainford, N. & Hall, J. E. (2016). Youth Violence Prevention Resource for Action: A Compilation of the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Note: The title of this document was changed in July 2023 to align with other Prevention Resources being developed by CDC's Injury Center. The document was previously cited as "A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors."

Youth Violence Prevention

Youth violence affects thousands of young people each day, and in turn, their families, schools, and communities. CDC works to understand the problem of violence experienced by youth and prevent it.

For Everyone

Public health.

Bullying and the Brain

Who this is for:.

Pick up your favorite young adult novel or start watching the latest teen drama on your favorite streaming app, and chances are, one of the major plot points will involve bullying. While such stories may lead you to believe that bullying, defined by the American Psychological Association as “a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort,” is just a childhood rite of passage, many studies show it can have long-term effects on an individual’s health and well-being. Research studies looking at links between bullying and the brain have demonstrated it also can have significant cognitive and emotional consequences, much like other adverse childhood experiences such as neglect or family violence. The results are so striking that bullying is now seen as a global public health problem with impacts on child, adolescent, and adult health.

What Is an Adverse Childhood Experience (ACE)?

An ACE is a negative or potentially traumatic event that occurs in childhood. ACEs can include physical, psychological, or sexual abuse, or neglect. It’s any prolonged or repeated experience that might undermine a child’s sense of safety and stability and, in doing so, lead to increased feelings of stress and social isolation.

The landmark ACEs study, a 1998 epidemiological review that looked at how childhood trauma can affect health later in adulthood, demonstrated that ACEs are directly correlated with mental health issues, substance abuse disorders, and chronic health problems such as obesity and cardiovascular disease.

Chronic bullying , or persistent physical or psychological abuse that may come from a family member or a friend, is considered an ACE. Like other ACEs, it can lead to overwhelming feelings of stress and isolation. Children who are bullied can develop anxiety, depression, and other mental health issues later in life, studies show. Bullying has also been linked to self-harm behaviors and even suicide. It’s a problem that scientists and public health experts now understand has a powerful impact on health, social, and emotional well-being.

How Common Is Bullying?

Between 15 and 22 percent of students between the ages of 12 and 18 experience some form of bullying, according to federal programs including the Department of Education’s 2022 Indicators of School Crime and Safety and the Center for Disease Control and Prevention (CDC)’s 2021 Youth Risk Behavior Surveillance System . It is a problem widespread enough that the CDC, as well as a variety of mental health advocacy organizations , have called for more programs to prevent it from happening in schools across the US.

Are There Different Types of Bullying?

Bullying can come in many different forms. The most common types of bullying involve being the subject of rumors or lies, being consistently belittled, or called names. Some people may also be bullied physically, by being pushed or shoved, for example, or having their property taken or destroyed.

Another form, known as cyberbullying, is a relatively new type of bullying that takes place digitally. People can be bullied over the internet, whether it’s by receiving negative emails, text messages, or online comments—or having rumors or lies spread to others via social media. Regardless of the type of bullying, it is something to take seriously, especially when the person being bullied is experiencing increased stress or negative feelings in response.

How Does Bullying Affect the Brain?

Since the first ACEs study was published, researchers have tried to understand why experiences like bullying can lead to such negative health consequences. Those studies have led to new insights into how bullying can lead to changes to the brain .

For example, the IMAGEN project—a European research consortium studying adolescent brain development—looked at the effects of bullying on young adults. About 30 percent of participants in the study said they had experienced chronic bullying, and they reported higher levels of anxiety than those who hadn’t been bullied. When the researchers looked at fMRI scans of the bullied individuals, they discovered structural differences in the brain in areas like the putamen and caudate, both linked to anxiety disorders. Other studies have shown that chronic bullying is also linked to white matter changes in the brain , which may make the person more susceptible to depression.

A more recent review of studies found an expanded range of impact—with changes noted in a variety of brain areas implicated in emotional processing, including the amygdala and prefrontal cortex. The review authors also hypothesize, given the wide range of areas affected, that bullying likely affects the way these different regions interact with one another, making it more difficult for victims of bullying to understand emotional cues and regulate their emotions.

Other studies, using animal models and human participants, suggest that chronic bullying leads to an increased release of stress hormones, like cortisol, especially in brain areas involved with reward-processing. Not only do those chemicals make you more reactive to stress, in general, but over time, they can change the circuitry in the reward centers, which can put people at higher risk of developing a substance use disorder after trying alcohol, cigarettes, or other drugs.

Finally, the stress hormones released during bullying can also affect the immune system. Those hormones can lead to increased inflammation, which has been linked to both depression and anxiety disorders, as well as medical conditions such as hypertension and obesity. When you put it all together, the chronic stress involved with the experience of persistent bullying can lead to structural and functional brain changes that increase the risk of developing both mental and physical health problems into adulthood.

Are the Cognitive Changes Permanent?

The good news is that the brain is “plastic”—the networks and circuits in everyone’s brains have the ability to change over time in response to their environment. Even if you have experienced bullying at one point or another in your life, that doesn’t mean you will necessarily develop ACE-related health problems. That said, if you are experiencing depression, anxiety, or are using drugs or alcohol in an unhealthy way, it’s important to reach out to your primary care provider or a mental health professional. They can help.

Does Bullying Harm the Bully?

Studies with animals demonstrate that those who are bullied tend to show increased levels of stress hormones, and over time, those bullied animals tend to be more aggressive toward younger, smaller animals. In addition to that, a 2013 JAMA Psychiatry study in people found both bullies and their victims showed a higher prevalence of childhood psychiatric disorders, including anxiety and depression. The study also showed that bullies—and not their targets—were at a higher risk for developing antisocial personality disorder later in life. That said, it is hard to be sure, because the vast majority of children who end up bullying others have been bullied themselves. It is a vicious cycle.

What to Do If You or Someone You Know Is Being Bullied

If you are being bullied, talk to an adult you trust : a parent, teacher, coach, or other important person in your life. Most bullying happens where other people can’t see it, so when you can shine a light on it by talking about it, you can do your part to help prevent it from happening again. Mental Health America also offers recommendations on how to respond in situations where bullying is taking place, whether it’s in person or online. For example, tell bullies to stop in a calm, clear voice; try to keep yourself surrounded by other people in situations where you are likely to be bullied; and never respond to online bullies. Your specific plan for managing the problem will likely depend on the type of bullying you or someone you care about might be experiencing.

Remember: Bullying isn’t something everyone goes through, or just a “normal” part of childhood. It can and does have lasting consequences. Whenever you can prevent it from happening, you’re helping prevent the development of bullying-related mental and physical health issues, too.

*Updated March 2024

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Integrative Review of Qualitative Research on the Emotional Experience of Bullying Victimization in Youth

Elizabeth hutson.

1 College of Nursing, Ohio State University, Columbus, OH, USA

2 Behavioral Health Department, Nationwide Children’s Hospital, Columbus, OH, USA

The emotional experience of bullying victimization in youths has been documented primarily using quantitative methods; however, qualitative methods may be better suited to examine the experience. An integrative review of the qualitative method studies addressing the emotional experience of bullying victimization was conducted. From MEDLINE, Cumulative Index of Nursing and Allied Health Literature, PubMed, Education Information Resource Center, and PsycINFO, 14 English-language, peer-reviewed, qualitative studies were reviewed. Applying the Critical Appraisal Skills Programme, the quality of the studies was deemed sufficient. The range of emotional experiences reported included sadness, decreased self-esteem, embarrassment, fear, suicidal thinking, anger, feeling hurt, loneliness, powerlessness, helplessness, and confusion. Overall, these results were similar to those obtained from quantitative method studies, apart from the feeling of embarrassment. This integrative review confirmed and expanded the knowledge of emotional experiences of bullying victimization.

The systematic study of bullying in youths began in Scandinavia in the 1960s and 1970s with Olweus. He proposed that “a student is being bullied or victimized when he or she is exposed, repeatedly and over time, to negative actions on the part of one or more other students” (p. 755). Incorporating the attribute of power imbalance, the definition now includes that “the student who is exposed to negative actions has difficulty defending himself or herself” ( Olweus, 2013 , p. 755). Cyberbullying, a newer concept, has been defined as “willful and repeated harm inflicted through aggressive actions through the use of computers, cell phones, and other electronic devices” ( Hutson, 2016 , p. 67). There is disagreement in the scientific community in the defining attributes of cyberbullying, as well as whether cyberbullying is a form of bullying or a different concept altogether.

Nevertheless, bullying in childhood is a public health concern that has many negative consequences. Previous studies, including systematic reviews and meta-analyses, have found higher rates of depression, anxiety, suicidal thinking, psychiatric hospitalization, use of psychiatric medications, low self-esteem, missed school days, academic failure, psychosomatic problems, and aggressive/violent behavior in youths who have been exposed to bullying ( Arseneault, 2017 ; Gini & Pozzoli, 2013 ; Hinduja & Patchin, 2010 ; Moore et al., 2017 ; Sourander, Ronning, & Brunstein-Klomek, 2009 ; Ttofi, Farrington, & Lösel, 2012 ). Many of the consequences of bullying relate to the experience of emotional harm on the individual; depression, anxiety, and suicidal ideation are the most cited emotional consequences of bullying ( Bottino, Bottino, Regina, Correia, & Ribeiro, 2015 ; Moore et al., 2017 ). Suicidal ideation, suicidal behaviors, and completed suicide attempts related to bullying have been given increased exposure in the media ( Winburn, Winburn, & Niemeyer, 2014 ), and a meta-analysis by Holt et al. (2015) found a nearly 3-fold increase in suicidal behavior for victims of bullying. A recent systematic review and meta-analysis by Moore et al. (2017) showed evidence for the relationship between bullying (especially bullying victimization) and mental health consequences such as depression, anxiety, and suicidal ideation. In that review, significant associations were found between bullying victimization and depression, anxiety, poor general health, and suicidal ideation.

An important consideration in reviewing literature on bullying and the experienced emotional harm is that it has mostly been done via quantitative methods with self-reports. There are inherent measurement issues because there is limited research into the accuracy of self-report surveys in the measurement of bullying ( Vivolo-Kantor, Martell, Holland, & Westby, 2014 ). Some of the issues include reporting/responding bias and sensitivity and specificity issues. Importantly, there are limitations in relying on quantitative methods to study bullying, as quantitative methods do not allow for the exploration of youths’ perceptions of the emotional harm that bullying causes. Discovering youths’ perceptions of the experiences of bullying through qualitative methods will allow the research and clinical community to better create and refine bullying assessment and prevention programs, especially at the individual level.

Therefore, qualitative methods may be better suited to examine youths’ perceptions of the bullying experience. Qualitative methods allow researchers to explore the life of individuals, understand their lived experience, and describe and interpret cultural phenomena ( Creswell, 2013 ). Consequently, studies using qualitative methods have examined the experiences and perceptions of youths who have been involved with bullying including their reactions ( Athanasiades & Deliyanni-Kouimtzis, 2010 ; Side & Johnson, 2014 ), the coping skills they use when dealing with bullying ( Evans, Cotter, & Smokowski, 2017 ), and the motivations behind bullying ( Varjas, Talley, Meyers, Parris, & Cutts, 2010 ). It is important to note that there are also measurement issues in qualitative methods. Qualitative methods have been critiqued as being small-scale, biased, and lacking rigor; however, when completed according to previously defined methods, qualitative work can be valid, credible, and rigorous ( Anderson, 2010 ; Creswell, 2013 ).

Although qualitative method study findings about the emotional consequences of bullying have been published in the literature, a summary of these findings has not been published. Therefore, the purpose of this study was to perform an integrative review of the qualitative literature on the emotional experience of bullying victimization in youths. An integrative review method as proposed by Whittemore and Knafl (2005) was selected because it allows for the inclusion of both experimental and nonexperimental studies to understand a phenomenon. Specifically, the steps in an integrative review include (a) problem identification, (b) literature search, (c) data evaluation, (d) data analysis, and (e) presentation ( Whittemore & Knafl, 2005 ).

Problem Identification

The problem identified that guided this project was a lack of a synthesis of the qualitative method studies on the emotional experience of youths who are victims of bullying. Thus, the aims of the review were to describe succinctly the emotional experience of being a victim of bullying as detailed in the qualitative literature and to examine these results within the context of quantitative method study findings in the literature.

Literature Search Method

To complete a thorough review of the literature, the electronic databases searched were MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Education Information Resource Center (ERIC), and PsycINFO. In the EBSCO databases (CINAHL, ERIC, PsycINFO, and MEDLINE), searches were limited to peer-reviewed articles. No beginning date limit was used, and the search was conducted up to April 2017. The search terms were “bullying” and “qualitative.”

Inclusion criteria for this search are as follows: (1) qualitative or mixed-methods study addressing bullying, (2) pediatric population (<21 years of age), (3) participants described their emotional experience of bullying victimization, and (4) the article was published in a peer-reviewed journal. Articles were excluded if (1) they were published in a language other than English or (2) they were unpublished manuscripts (abstracts or dissertations). Although mixed-method studies were included only the qualitative data were addressed in this integrative review.

Citation titles were first assessed. For titles that indicated qualitative methods to study the experiences/perceptions of youths involved with bullying, abstracts were reviewed for the inclusion and exclusion criteria. For abstracts that met inclusion criteria, the full-text articles were retrieved and fully evaluated for inclusion and exclusion criteria. The study selection process and results can be found in Figure 1 . Ultimately, 14 manuscripts were found that met the established inclusion criteria. Data from the 14 studies can be found in Table 1 .

Study selection.

Article Review Table.

Data Evaluation

Evaluating and interpreting quality of primary sources in an integrative review can be challenging, as noted by Whittemore and Knafl (2005) . Because qualitative methods were used for the studies included, a quality instrument that specifically assesses qualitative methods was used: the Critical Appraisal Skills Programme ( CASP; 2014 ; Lee, 2006 ). The CASP (2014) qualitative checklist was designed by a group of experts to be used, when reading qualitative literature to think about the quality of qualitative methods in a systematic way. This instrument was used to judge whether the article explicitly identified an aim, method, research design, recruitment strategy, data collection method, ethical issues, data analysis techniques, findings, added value to the literature, and whether the relationship between the researcher and participants was adequately considered. Based on the criteria from the CASP instrument, no articles were excluded due to quality issues. In general, the quality of the studies was determined to be sufficient. All studies had an appropriate methodology, reported their findings, and added value to the literature. The largest area of concern was the relationship between the researcher and participants; five of the studies did not address this issue ( Athanasiades & Deliyanni-Kouimtzis, 2010 ; Bell et al., 2014 ; Kulig, Hall, & Kalischuk, 2008 ; Lindsay & McPherson, 2012 ; Side & Johnson, 2014 ). This is an important area to address because bias can be introduced if the researcher does not examine her or his role and influence in the qualitative data collection process.

Across the 14 studies, different types of qualitative methods were used. Phenomenological methods were most commonly used ( n = 5), including the subtypes of interpretative phenomenological analysis ( Athanasiades & Deliyanni-Kouimtzis, 2010 ), the phenomenological hermeneutic mode of understanding ( Kvarme, Helseth, Sæteren, & Natvig, 2010 ), transcendental phenomenology ( Brown Hajdukova, Hornby, & Cushman, 2016 ), the descriptive phenomenological method ( Willis & Griffith, 2010 ), and general phenomenology ( Pister, 2014 ). Grounded theory methods were also used in three of the studies ( Pister, 2014 ; Shea & Wiener, 2003 ; Tenenbaum, Varjas, Meyers, & Parris, 2011 ). Two studies cited thematic semantic analysis as their method ( Berne, Frisén, & Kling, 2014 ; Side & Johnson, 2014 ). One study used qualitative description ( Kentel & McHugh, 2015 ), and another cited basic qualitative methodology ( Mishna, Wiener, & Pepler, 2008 ). Three studies did not mention a specific qualitative method that guided their work ( Bell et al., 2014 ; Kulig et al., 2008 ; Lindsay & McPherson, 2012 ).

Although the focus of this review was qualitative method studies, it is important to mention that four of the studies also included quantitative components, namely, self-report Likert-type scale surveys; therefore, they are classified as mixed methods ( Bell et al., 2014 ; Kulig et al., 2008 ; Mishna et al., 2008 ; Side & Johnson, 2014 ). Another important consideration is that studies included different types of interview methods: five of the studies used focus groups ( Athanasiades & Deliyanni-Kouimtzis, 2010 ; Bell et al., 2014 ; Berne et al., 2014 ; Kvarme et al., 2010 ; Tenenbaum et al., 2011 ), five used individual interviews ( Kentel & McHugh, 2015 ; Mishna et al., 2008 ; Pister, 2014 ; Shea & Wiener, 2003 ; Willis & Griffith, 2010 ), and four used both focus groups and individual interviews ( Brown Hajdukova et al., 2016 ; Kulig et al., 2008 ; Lindsay & McPherson, 2012 ; Side & Johnson, 2014 ).

Data Analysis

Data collected and analyzed for this integrative review were explicitly identified prior to beginning the data collection process, as proposed by Whittemore and Knafl (2005) . Data for each article were extracted, including the terms used to describe the emotional experience of bullying victimization, sample size and characteristics, any special populations recruited, the country in which the research took place, the setting of the research, and strengths and limitations. Data regarding the emotional experience were taken from both the write-up in the article and the quotations from participants in the studies. Once extracted, the data from all primary sources were displayed in a chart and were compared iteratively.

Articles were published between 2003 and 2016. The sample size in the studies ranged from 4 to 102 participants. Participants were between the ages of 8 and 19 years. Studies were conducted in Canada, Greece, New Zealand, Norway, Sweden, the United Kingdom, and the United States. Most of the research was conducted in the school setting ( Athanasiades & Deliyanni-Kouimtzis, 2010 ; Berne et al., 2014 ; Brown Hajdukova et al., 2016 ; Kentel & McHugh, 2015 ; Kulig et al., 2008 ; Kvarme et al., 2010 ; Mishna et al., 2008 ; Pister, 2014 ; Side & Johnson, 2014 ; Tenenbaum et al., 2011 ; Willis & Griffith, 2010 ), two were performed in the community or home setting ( Bell et al., 2014 ; Shea & Wiener, 2003 ), and one in a pediatric rehabilitation center ( Lindsay & McPherson, 2012 ).

Some of the studies recruited specialty populations to describe their specific bullying experience. Certain studies selected participants with a specific diagnosis, such as attention deficit hyperactivity disorder ( Shea & Wiener, 2003 ) or cerebral palsy ( Lindsay & McPherson, 2012 ), while one included participants based on the general diagnosis of social, emotional, and behavioral difficulties ( Brown Hajdukova et al., 2016 ). Others recruited based on inclusion in an ethnic or cultural group, such as Lumbee youth ( Bell et al., 2014 ), Canadian Aboriginal youth ( Kentel & McHugh, 2015 ), or rural youth ( Kulig et al., 2008 ). A few of the studies aimed to look at specific gendered experiences related to bullying; thus, they only recruited males ( Brown Hajdukova et al., 2016 ; Shea & Wiener, 2003 ; Willis & Griffith, 2010 ) or females ( Kentel & McHugh, 2015 ).

Emotions Experienced

There was a range of emotional experiences related to being a victim of bullying discussed in the articles ( Table 2 ). One of the most commonly mentioned emotions was sadness or depression; this response was found in 10 of the articles ( Bell et al., 2014 ; Berne et al., 2014 ; Brown Hajdukova et al., 2016 ; Kentel & McHugh, 2015 ; Kvarme et al., 2010 ; Mishna et al., 2008 ; Shea & Wiener, 2003 ; Side & Johnson, 2014 ; Tenenbaum et al., 2011 ; Willis & Griffith, 2010 ). The youths reported words such as sad, sadness, or “feel down” ( Kentel & McHugh, 2015 , p. 370). Self-esteem issues were also often mentioned, reported in seven of the articles ( Athanasiades & Deliyanni-Kouimtzis, 2010 ; Bell et al., 2014 ; Berne et al., 2014 ; Kentel & McHugh, 2015 ; Kulig et al., 2008 ; Kvarme et al., 2010 ; Willis & Griffith, 2010 ). In particular, the youths described feeling “not as good as the others” ( Kvarme et al., 2010 , p. 795). Another emotional reaction mentioned in seven of the articles was embarrassment or shame ( Berne et al., 2014 ; Kentel & McHugh, 2015 ; Kulig et al., 2008 ; Lindsay & McPherson, 2012 ; Shea & Wiener, 2003 ; Side & Johnson, 2014 ; Tenenbaum et al., 2011 ). In one article, a participant reported that the experience was “humiliating” ( Side & Johnson, 2014 , p. 225).

Emotions Experienced.

Other emotional reactions were mentioned in fewer studies, and exemplar quotes are provided in Table 2 . Six of the studies mentioned suicidal thinking ( Bell et al., 2014 ; Berne et al., 2014 ; Kulig et al., 2008 ; Kvarme et al., 2010 ; Shea & Wiener, 2003 ; Side & Johnson, 2014 ) and anxiety or fear ( Athanasiades & Deliyanni-Kouimtzis, 2010 ; Kvarme et al., 2010 ; Mishna et al., 2008 ; Shea & Wiener, 2003 ; Side & Johnson, 2014 ; Willis & Griffith, 2010 ). Five of the studies mentioned feeling hurt ( Kentel & McHugh, 2015 ; Kvarme et al., 2010 ; Mishna et al., 2008 ; Pister, 2014 ; Tenenbaum et al., 2011 ), anger ( Brown Hajdukova et al., 2016 ; Mishna et al., 2008 ; Shea & Wiener, 2003 ; Side & Johnson, 2014 ; Willis & Griffith, 2010 ), and feeling excluded or lonely ( Brown Hajdukova et al., 2016 ; Kvarme et al., 2010 ; Lindsay & McPherson, 2012 ; Mishna et al., 2008 ; Shea & Wiener, 2003 ). Lastly, two of the studies reported feelings of helpless and powerlessness ( Kvarme et al., 2010 ; Side & Johnson, 2014 ) and confusion ( Mishna et al., 2008 ; Willis & Griffith, 2010 ).

We analyzed the findings from qualitative research about the emotional experience of bullying victimization in youths. This is an important contribution to the literature because much of the previous work on the emotional consequences of bullying comes from quantitative research. This review of the qualitative literature found that youths who were victims of bullying used many emotional adjectives to describe their feelings: (in order of prevalence) sadness, decreased self-esteem, embarrassment, fear, suicidal thinking, anger, feeling hurt, loneliness, powerlessness, helplessness, and confusion.

Examining the findings from this review and placing them within the context of prior findings resulting from quantitative method studies may provide additional insight into the effect of bullying victimization. As bullying research has grown, multiple systematic reviews and meta-analyses have been published documenting the quantitative method study findings, which is the strongest level of evidence ( Melnyk & Morrison-Beedy, 2012 ). A recent systematic review and meta-analysis were done examining bullying victimization and found statistically significant relationships between bullying victimization and depression, anxiety, nonsuicidal self-injury, and suicidal ideation. Odds ratios were calculated for the abovementioned emotional consequences. Highest odds ratios were found between frequent bullying victimization and (a) depression and (b) suicide attempts. A nearly fourfold increase in suicide attempts was found for youths who experience frequent (as opposed to “sometimes”) bullying victimization ( Moore et al., 2017 ). Similar results were found in a systematic review of cyberbullying and adolescent mental health. Findings from that study indicated that adolescents who were victims of cyberbullying were more likely to report symptoms of depression and suicidal ideation and behaviors ( Bottino et al., 2015 ). Another meta-analysis found moderate effect sizes for bullying victimization and suicidal ideation and suicidal behavior ( Holt et al., 2015 ). A meta-analysis was also performed looking at bullying victimization and self-esteem and found a significant negative correlation, meaning that as youths were more frequently bullied their self-esteem decreased ( Tsaousis, 2016 ).

The above mentioned systematic reviews and meta-analyses found results similar to this integrative review, in that the emotional reactions often mentioned included depression or sadness, anxiety or fear, suicidal ideation, and self-esteem issues. The current review reported herein additionally found that youths often report embarrassment as an emotional reaction to bullying, which has not previously been documented in quantitative research. Therefore, the new results found in this review point to a need to include measures on embarrassment or shame in future studies on bullying victimization. Importantly, many youths who are victims of bullying do not tell adults about the situation; therefore, feelings of embarrassment or shame should be explored in future studies as a potential reason for the lack of reporting.

Strengths and Limitation of the Research Designs

Results of this review contribute to the growing field of literature on the consequences of bullying, in particular the emotional consequences. This review provides the first integrated review of the literature using qualitative methods to describe the emotional experience of bullying victimization of youths. Rigorous methodology as proposed by Whittemore and Knafl (2005) guided this review.

In the 14 qualitative studies included in this review, one strength was that most of the studies ( n = 11) explicitly stated the qualitative method used. It is important to be transparent in stating the qualitative methods used so that studies can be assessed for rigor, which has been a criticism of qualitative methods ( Anderson, 2010 ). Another strength of the research designs was that some of the studies used validation techniques recommended by Creswell (2013) . For example, Mishna, Wiener, and Pepler (2008) used triangulation with parents, teachers, vice principals, and principals to validate their findings. Shea and Wiener (2003) also used triangulation with teachers and parents. Kentel and McHugh (2015) used member checking to verify the results of their analysis with their participants. They also used prolonged engagement or spending extended time with the participants in their everyday world ( Creswell, 2013 ). Other researchers used constant comparison ( Berne et al., 2014 ; Kulig et al., 2008 ; Mishna et al., 2008 ; Shea & Wiener, 2003 ), as defined by Strauss and Corbin (1990) . The use of these validation methods is a strength of these particular studies; however, many authors did not explicitly discuss their validation methods, a major limitation of their research designs. Therefore, future qualitative work should consistently describe validation techniques to ensure the rigor of the research design.

Limitations among the studies included lack of design description in three of the studies ( Bell et al., 2014 ; Kulig et al., 2008 ; Lindsay & McPherson, 2012 ) and variance among the data collection techniques (focus groups, individual interviews, or both).

Limitations of This Review

First, though bullying is the most common term used to describe this phenomenon in the English language, other terms are used, such as “cyber mobbing” or “peer victimization” ( Nocentini et al., 2010 ). Importantly, Nocentini and colleagues (2010) found that the term bullying arose consistently among youths when describing these behaviors, which is why only this term was included in the literature search. The broad term “qualitative” was also exclusively selected for the literature search because this would capture all research using qualitative methods, as opposed to limiting it to specific types of qualitative methods (i.e., grounded theory).

An important limitation of qualitative research is that authors may group content into themes, thus leaving out other terms the participants may have used to describe their emotional experience. Because this is the standard way to organize qualitative method studies, this is an inherent problem that could not be controlled for in this review. Many of the reviewed studies commented on this limitation and mentioned their use of constant comparison in grounded theory designs ( Strauss & Corbin, 1990 ) or open coding ( Kentel & McHugh, 2015 ; Pister, 2014 ; Shea & Wiener, 2003 ) to mitigate this limitation.

Implications for School Nurses

As one in five youths report being the victim of bullying on school property, bullying can be seen as a public health concern for youths in the school setting ( Kann et al., 2016 ). Consequently, school staff, especially school nurses, frequently encounter students who have been victims of bullying and suffer from adverse physical and emotional outcomes. The school setting is frequently where these students first present with concerns related to bullying; therefore, school nurses are often the first health-care provider to encounter, assess, and help treat these students. It is important for school nurses to be aware of the emotional experiences that were found in this review that may result from bullying victimization.

Based on this review, there are two main recommendations for school nurses when working with children who have been victims of bullying. First, it is important to note that youths often do not feel comfortable talking to an adult, including school staff, when they are experiencing bullying because they are worried about the adults overreacting to the situation or they are worried about being blamed for the situation ( Fenaughty & Harré, 2013 ). As was found by this review, feelings of embarrassment may also contribute to students’ reluctance to tell an adult when they are victims of bullying. Therefore, when school nurses encounter youths with the emotional symptoms found from this review (sadness, decreased self-esteem, embarrassment, fear, suicidal thinking, anger, feeling hurt, loneliness, powerlessness, helpless, and confusion), they should be suspect of bullying victimization and screen the student appropriately. This is in line with the position statement from the National Association of School Nurses (NASN) on Bullying Prevention in Schools , in that school nurses should be key players in identifying and responding to bullying in schools ( DeSisto & Smith, 2014 ). This recommendation from this review goes further to recommend that students with emotional symptoms frequently associated with bullying be screened for bullying rather than just unexplained somatic symptoms as recommended by the position statement ( DeSisto & Smith, 2014 ).

The second recommendation is that, when a student does present to the school nurse or other school staff with concerns related to bullying victimization, they should be screened for depression, anxiety, suicidal thinking, and decreased self-esteem (some of the most cited emotional consequences found from this review) and referred to the appropriate treatment services. This is an important recommendation because some students may not openly admit to the cause of adverse emotional experience unless directly asked. Again, this goes beyond the NASN position statement that school nurses should recognize and be knowledgeable about long-term consequences of bullying, but also that school nurses should screen students affected by bullying for emotional symptoms and refer to the appropriate treatment ( DeSisto & Smith, 2014 ).

Results generated from qualitative studies can provide valuable information documenting the emotional experience of youths who have been victims of bullying. Because most previous studies examining the negative consequences of bullying victimization have used quantitative methods, this review of qualitative method studies is an important addition to the literature. The results of this integrated review found that documented emotional experiences in youths who are victims of bullying include sadness, decreased self-esteem, embarrassment, fear, suicidal thinking, anger, feeling hurt, loneliness, powerlessness, helplessness, and confusion. An important distinction between previous quantitative studies documenting the consequences of bullying victimization and this review is that this review found embarrassment was the second most commonly mentioned emotional experience (along with decreased self-esteem). This finding points to a need to include measures on embarrassment in studies addressing bullying.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biography

Elizabeth Hutson , MS, RN, PMHNP-BC, is a doctoral student at Ohio State University.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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