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Due, P., Holstein, B. E., Lynch, J., Diderichsen, F., Gabhain, S.N., Scheidt, P., … The Health Behaviour in School-Aged Children Bullying Working Group. (2005). Bullying and symptoms among school-aged children: International comparative cross sectional study in 28 countries. European Journal of Public Health, 15, 128-132.

Recent studies have suggested that bullying is a precursor for health problems in childhood; for example, Bond, Carlin, Thomas, Rubin, and Patton (2001) found victimization to predict onset of emotional problems. Tragic violent incidents in schools in several countries have pointed at violent behavior as an important issue of concern among school children. The current study by Due et al. (2005) examined the prevalence of bullying among adolescents from 28 countries and the associations between levels of bullying and twelve psychological symptoms.

The researchers in the current study used data from 28 countries from the 1997/1998 Health Behaviour in School-aged Children (HBSC) survey, a standardized, international WHO collaborative survey. Each national study included students in the relevant age groups (11, 13 and 15 year olds) from a random sample of schools. In total, the study comprised 123,227 students. Bullying was measured by the item: ‘During this term, how often have you been bullied at school? ’The responses were recoded into three levels: (1) never/once or twice, (2) sometimes, and (3) about every week/all the time. Mental health status was measured by self-reported frequency of 12 symptoms. ‘Loneliness’ was dichotomized into very often/ rather often versus sometimes/never. ‘Tired in the morning’ was dichotomized into once a week or more versus less. The two remaining symptoms, ‘feeling left out of things’ and ‘feeling helpless’ were dichotomized into always/often versus sometimes /rarely/never.

Results: The proportion of students who reported being bullied at least sometimes during the term showed large variations across countries. 17.5% of boys versus 16.2% of girls reported experiencing bullying at least sometimes during the term in France. For Canada, 17% of boys compared to 12.3% of girls reported experiencing bullying at least sometimes during the term. Lastly, in the United States 16% of boys compared with 11.3% of boys reported experiencing bullying at least sometimes. The prevalence of bullying decreased with age in all countries, except Scotland. In all countries except Hungary and Russia more boys than girls were victims of bullying, but in most countries sex differences were small. The prevalence of symptoms and the prevalence of bullying across countries were uncorrelated (r for boys =-0.03, n =28, p= 0.0624; r for girls =-0.08, n=28, p=0.6800). For both boys and girls a graded association between experience of bullying and the prevalence of each of the symptoms occurred. The relationship was stronger for psychological symptoms such as feeling left out, bad temper, feeling helpless, feeling nervous and low, difficulties in getting to sleep, morning tiredness, and loneliness than for physical symptoms. The prevalence of each of the symptoms increased by frequency of bullying with only one exception: among adolescents in Greenland.

Discussion: The study by Due et al. (2005) showed great variation in bullying and symptom prevalence across countries, but between-country differences in the prevalence of bullying were unrelated to international variation in the prevalence of psychological symptoms. Despite this, within all countries, the researchers discovered a consistent pattern of graded associations of symptoms with bullying with high levels of mental health symptoms for both boys and girls. Exposure to bullying may cause poorer physical and psychological health in adolescents. This will influence not only the well-being of the adolescent, but possibly also their academic and social development. Adolescence is a developmental period that is strongly influenced by relationships with family and peers; adolescents may therefore be especially susceptible to the mental health effects of negative social interactions or bullying. Bullying not only has a wide range of contemporary effects for the victims but also has serious long-term effects on health and well-being later in life. Intervention programs have demonstrated an effect on diminishing bullying within the school environment. The most comprehensive work in this area has been performed by Olweus, who has pointed out the importance of intervening at different levels to successfully diminish the level of bullying in the school environment. It is recommended that it be made harder to actually perform the behavior by increasing inspection in breaks and at other occasions, when bullying is likely to occur. It is important to create mutual behavioral norms among the group of children by letting the pupils themselves define rules for acceptable social behavior in the group. Regular discussions in the group on how these rules are observed are essential.