Involvement in bullying linked with poor psychosocial adjustment

August 02, 2004

CHICAGO - Being a bully or victim of bullying was consistently associated with poor psychosocial adjustment for students from 25 countries, according to an article in the August issue of The Archives of Pediatrics & Adolescent Medicine, a theme issue on mental health and one of the JAMA/Archives journals.

According to information in the article, "Recent studies on school-aged children in Australia, England, Finland, Germany, Scotland, and the United States suggests that bullying is associated with adverse outcomes for both the victim and the bully, including poorer social, emotional, and physical health. Findings from research in Australia, Finland, and Norway indicate that these psychosocial challenges may persist into later adolescence and adulthood."

Tonja R. Nansel, Ph.D., of the National Institute of Child Health and Human Development, Bethesda, Md., and colleagues compared the relationship between being bullied and bullying others with physical health, emotional adjustment, school adjustment, peer relationships, alcohol use and carrying weapons. The researchers surveyed a total of 113,200 adolescents from 25 countries when students were at the following average ages: 11.5 years, 13.5 years, and 15.5 years.

The researchers found that involvement in bullying ranged from 9 percent of youths surveyed in Sweden to 54 percent of youths surveyed in Lithuania. Across all countries surveyed, bulling was associated with poor psychosocial functioning. In nearly all countries, bullies, victims and bully-victims (youth who reported both being bullied and bullying) had more health problems and worse emotional and social adjustment. Victims and bully-victims also reported more alcohol use and were more likely to carry weapons.

"Significant differences in the overall prevalence of bullying among countries, as well as the proportion of victims, bullies, and bully-victims, were observed; yet the consistency of findings regarding the relationship between bullying and psychosocial adjustment is striking," the authors write. "This suggests that being the victim or perpetrator of abusive social relationships may have an adverse effect on youths' physical, emotional, and social development."

(Arch Pediatr Adolesc Med. 2004;158:730-736. Available post-embargo at

Editorial: International Trends in Bullying and Children's Health

In an accompanying editorial, Patrick H. Tolan, Ph.D., of the University of Illinois at Chicago, writes, "The issue of youth violence, particularly the more common but less dramatic version that is represented in bullying, had been considered worthy of educational and child development concern in many countries. However, at the same time, there has been skepticism about the importance of focusing resources on it because it is considered mild harm, almost normative, and perhaps a luxurious worry (because of low morbidity effect)."

"At least, these data [by Nansel et al] suggest there are real child development problems that can be associated with bullying, whether measured by social and emotional development or social functioning. While not dramatic relations, they are not insubstantial either. When projected onto a public health perspective and population effects and associated health and educational costs, the effect is disturbing," Dr. Tolan writes.

"While there are persons who are only bullies and certainly there are a substantial number of victims who have not been or do not go on to be bullies, there is considerable overlap in the population of both groups of concern to health and child development professionals. The implication for public health is that there is value in targeting both groups, but more so, the intervention planning should include recognition of this considerable overlap."

"I think this article has one more implication that is particularly noteworthy, although this is not directly extractable from these data and the study reported here. That implication is about bullying as an insidious impediment to child development and contributor to morbidity and related health costs," writes Dr. Tolan. (Arch Pediatr Adolesc Med. 2004;148:730-736. Available post-embargo at
For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail

To contact Tonja R. Nansel, Ph.D., call Robert Bock at 301-496-5133. To contact editorialist Patrick H. Tolan, Ph.D., call Sharon Butler at 312-355-2522.

The JAMA Network Journals

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