Bullying behavior is the new public health concern


Twenty years of research makes it clear that between 5% and 20% of pupils in schools are bullied and between 2% and 20% of students are bullies, according to a new book from the American Public Health Association (APHA).


Twenty years of research makes it clear that between 5% and 20% of pupils in schools are bullied and between 2% and 20% of students are bullies, according to a new book from the American Public Health Association (APHA).

Even after more than 15 years of heightened awareness, most of the research on health problems related to bullying originates from outside the United States and most is based on self-reports by students, according to a chapter written by Diana Schroeder, MSN, RN, director of bullying prevention initiatives at Windber Research Institute, Pennsylvania. Most of the studies come from the psychological community and others from the medical community, she says.

Schroeder states the health outcomes most commonly associated with bullying are psychosomatic, and physical injuries are those least commonly associated.

Unfortunately, most evidence supporting association between being bullied and mental health problems is looking at the children within a short time of the events, writes Gianluca Gini, PhD, of the University of Padova, Italy, in another chapter. However, the few studies looking at long-term outcomes report that bullied children “show adjustment problems also in late adolescence and in adulthood.” For example, 1 meta-analysis of 29 longitudinal studies found that bullying victims are twice as likely to report depression later in life than noninvolved students.

Gini points out that some research indicates early bullying behavior is linked to later criminal behavior and other antisocial behaviors, and increased attention is being given to a possible comorbidity of bullying and early substance use. Bullying might represent a warning sign for other problem behaviors, he says.

On the other hand, Gini notes, “According to the literature, among the many protective factors that can be identified, parental and school support play important protective roles in children and adolescent development and well-being.”

Schroeder advises communities to create communication avenues for educating healthcare providers about schools’ bullying policies and programs, and ways for providers to talk to the school if there is a concern about a child being bullied. She advises healthcare professionals to regularly ask children and families about a child’s exposure to bullying and other aggressive behaviors at school.

Among the risk factors associated with bullying, Schroeder says, are mental health or behavioral issues; being gay or being perceived to be gay; and being emotionally abused or neglected at home.

Screening requires a plan for follow-up if there is an issue, Schroeder warns, and the professional may consider contacting the school nurse, counselor, or principal. The healthcare professional’s expertise on the health consequences of bullying may increase awareness at the school, she says.

There are 4 school policies that some federal partners in bullying prevention advise schools against, says another chapter contributor Susan P. Limber, PhD, of Clemson University, South Carolina. They are zero-tolerance policies that include punishments such as suspension and expulsion for students who bully; conflict resolution and student mediation efforts because by definition there is a power imbalance between the bully and the victim; group treatment for bullies that may reinforce antisocial behavior; and most short, simple solutions.

The recommended policy is the comprehensive bullying prevention program developed by Dan Olweus, PhD, in Norway in the early 1980s. It includes showing warmth and interest in the students, establishing firm but reasonable rules for behavior, and having consistent but nonhostile consequences.

Some of the program’s components include supervising students’ activities; ensuring that all staff intervene immediately when they see bullying; meeting separately with students doing the bullying and those being bullied; meeting with the parents of students involved; and developing individual interventions as needed.

Other chapters in the book focus on school climate reform; practical implications for the school administrator; and economic evaluation of bullying prevention programs.

A Public Health Approach to Bullying Prevention by Matthew G. Masiello, MD, MPH, and Diana Schroeder, MSN, RN, can be purchased in both book and e-book formats at the APHA’s online bookstore.

The US Department of Health and Human Services website www.stopbullying.gov offers various federal and nonfederal toolkits, training materials, and a listing of state policies and laws in addition to other resources for bullying prevention.


Ms Foxhall is a freelance writer in the Washington, DC, area. She has nothing to disclose in regard to affiliations with or financial interests in any organizations that might have an interest in any part of this article.

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