(From Youth Studies, Australia 17,1, 13-17, 1998.)
Author Ken Rigby, University of South Australia
Brief Abstract
There is now reliable evidence that the experience of frequent victimisation by peers at school is associated with relatively poor mental and physical health among young people. This article reviews relevant evidence from overseas and Australia, and describes a recent longitudinal study in South Australia which suggests that constantly being bullied at school in early adolescence can have enduring negative health consequences.
Acknowledgment
The author would like to acknowledge the support given to the studies of peer victimisation and student health provided by Australian Rotary Health, and also to the help provided by Dr. Phillip Slee in the planning of the Australian studies, and Ms Robyn Cunningham for assistance in data analysis.
INTRODUCTION
Since the 1960s we have become accustomed to believing that poor health may result from the accumulated experience of stressful life events. According to Holmes and Rahe (1967) who pioneered research into the adverse effects of stress on individual well-being, the majority of stressful events are social in nature and typically involve difficult interpersonal relations in the home or in the workplace. Yet it is only quite recently that it has been recognised that the health and well-being of young people can be seriously affected by the quality of relations they have with their peers at school, which is, of course, where young people between the ages of 5 and 16 years normally spend most of their days.
BULLYING
Recognition of the harm done by difficult peer relations has been greatly sharpened by recent studies of bullying or peer victimisation at school. We now know that bullying at school is not a rare event encountered by "abnormal" students. In Australia for instance, large scale surveys of more than 25,000 students have shown that in the course of any one year as many as half the students attending school experience painful and unjustified aggression from students who are physically, psychologically or numerically more powerful than themselves (Rigby, 1997a). A substantial proportion of these students, about 1 in 7, are bullied weekly or more often. Some of these students are very resilient and appear to be unaffected by the experience. However, many of them report being continually emotionally upset or depressed following repeated incidents of peer victimisation.
AIM
As yet comparatively little research has been published that assesses the nature, extent and duration of the effects of bullying on the physical as well as the mental health of young people. In this article my aim is to describe what is indicated by the research that has been conducted overseas and in Australia, drawing especially on results from a series of relevant studies conducted with adolescent school students by South Australian researchers between 1993 and 1997. These studies were funded by Australian Rotary Health and conducted by myself and Dr. Phillip Slee from Flinders University.
CROSS-SECTIONAL SURVEYS
The bulk of the research into the relationship between peer victimisation and children's health has been conducted through the use of cross-sectional surveys in which students answered questions about the extent to which they had been recently victimised and also their level of health or well-being. Most of the studies have utilised questions relating to the mental health of students, for example, their self-esteem, general happiness, and levels of anxiety and depression. Fewer reports have attempted to assess the physical health of children and relate this to the extent of peer victimisation. A summary of research findings is given in Table 1.
Table 1
Summarised results from cross-sectional surveys on the relationship between peer victimisation and (i) student mental health and well-being and (ii) student physical health
(i) Studies of mental health
Olweus (1978) Swedish male victims of school bullying aged 11 years assessed as being relatively anxious and insecure.
O'Moore and Hillery (1991) Irish schoolchildren (aged 7 to 13 years): Victims of school bullying had significantly lower self-esteem.
Rigby and Slee (1993) Australian Secondary School students (aged 12 to 18):Levels of self-esteem and happiness were significantly lower among students reporting a higher degree of peer-victimisation.
Boulton and Smith (1994) English middle school victims of bullying (aged 8-9 years), as nominated by peers, had significantly lower scores than others on a measure of global self-worth.
Mynard and Joseph (1997) English schoolchildren (aged 8 to 13 years) who reported being bullied relatively frequently at school indicated lower levels of global self-worth and social acceptance by others.
Zubrick et al (1997) Western Australian schoolchildren (aged 5 to 18 years) identified as being bullied at school were more likely to experience significant mental health problems.
Rigby (1994; 1997c) In two studies with Australian High School students (12 to 16 years) victimised students scored significantly higher on the General Health Questionnaire assessing frequency of psychiatric symptoms.
(ii) Studies of physical health
Williams et al (1996) English Primary School children: Symptoms of poor health (headaches and stomach aches) more common among children reporting as bullied by peers.
Rigby and Slee (1998) Australian Secondary students: Physical health symptoms were significantly more common among students bullied in Junior High School, though not among Senior High School students.
It is evident from the results summarised in Table 1 that there has been a fairly high level of consistency in studies addressing the question of whether student health is significantly related to reported peer victimisation. The exception relates to a recent study conducted with senior high school students, aged 15 to 17 years (Rigby and Slee, 1998). For this group of older students - who according to their self-reports are victimised by peers relatively infrequently - peer-victimisation was unrelated to health status for either male or female students. From these results it appears that the association of relatively poor health, both physical and mental, with current or recent peer victimisation may be limited to younger adolescent students.
RESEARCH EMPLOYING DATA BASED ON PEER NOMINATIONS
There is a problem in relying exclusively on self-report data. One may suspect that reporting that one is being victimised a lot and reporting that one is not feeling well may be part of a more general tendency to complain about things. One way of countering this problem is to derive categories of "victims" and "others" from peer-nominations rather than from self-reports. This was done in a study of adolescent students from South Australian schools in 1994. It was found that those categorised as victims by a comparatively large proportion of their peers scored significantly higher than others on the General Health Questionnaire (GHQ) measure of psychiatric symptoms: that is, they showed significantly poorer mental health. On items taken from the GHQ assessing suicidal ideation, those categorised as victims on the basis of peer nominations were significantly more likely to engage in suicidal thinking (Rigby, 1997b).
LIMITATIONS OF CROSS-SECTIONAL RESEARCH
A widely recognised weakness of cross-sectional research lies in its inability to provide indications of causality. For example, the correlation between low self-esteem and high levels of peer victimisation, demonstrated in several research reports, may mean that it is not bullying that induces low self-esteem but rather having low self-esteem attracts bullying. Arguably, appearing to lack confidence may result in a child being victimised. In some environments one might expect that a child who is physically weak will be selected as a target by bullies. One of the leading researchers in the field of bullying research, Professor Dan Olweus in Norway, has claimed that one of the main characteristics of male victims in schools is that they are generally not as physically strong as others.
To some extent, the problem of the direction of causality may be countered by asking students how they feel after they have been bullied by someone. This has been done in several studies. For example, in a study of the personal well-being of English secondary school students, Sharp (1995) reported that as many as 30% of students who had been bullied at school indicated that as a consequence they had felt irritable, panicky or nervous, and had experienced recurring memories of the bullying incident. Similarly, in a recent large scale Australian study, substantial proportions of both Primary and Secondary students reported feeling worse about themselves and also to feeling sad and miserable (Rigby, 1997a). Further, the more frequently a student reported being bullied, the more often he or she also reported that bullying induced a lowering of self-esteem, an increase in emotional distress and an avoidance of going to school. Nevertheless, however persuasive these results may seem, we should bear in mind that the respondents in these studies could have been saying what they thought the researcher would like to hear.
THE NEED FOR LONGITUDINAL STUDIES
More adequate studies involve longitudinal research designs. As yet, few have been applied to the question of whether earlier experiences of bullying at school constitute a risk factor for subsequent health. There have been two relevant studies conducted outside Australia. Olweus (1993) in Norway reported that children who were frequently victimised in Primary School tended to have comparatively low levels of self-esteem when they were assessed in their twenties and also to suffer bouts of depression. In a recent study in the United States, young children in Primary School were repeatedly assessed for signs of (i) being victimised by peers and (ii) being maladjusted at school. The authors concluded that the maladjustment they observed in children followed being victimised rather than being a precursor (Kochenderfer and Ladd, 1996). Until recently, it appears that no longitudinal studies of the relationship between bullying and mental or physical health had been conducted over the adolescent years from early to mid-teens.
AN AUSTRALIAN LONGITUDINAL STUDY
This involved administering a questionnaire twice to students attending a coeducational school in 1994 and 1997. In total 78 students provided data relating to their mental and physical health and also how frequently they had been victimised in the current year. Thus we had data from students at different stages in their lives: as Junior High School students when they were 12-13 years old and again three years later when they were Senior students.
Both questionnaires administered in classrooms at the school contained a reliable measure of the frequency of peer victimisation and measures of mental and physical health. Results on all the measures were treated confidentially. The instruments are described briefly and illustrated in Table 2.
Table 2
Measures used in the Australian longitudinal study of the effects of peer victimisation on subsequent health status.
Peer Victimisation. Assessed by asking students how often during the current year they had been bullied by other students in each of five ways: namely, being teased in an unpleasant way; being called hurtful names; being left out of things on purpose; being threatened with harm; being hit or kicked. Response categories are: never, sometimes and often.
Mental Health This employed 21 items from the General Health Questionnaire devised by Goldberg and Williams (1988). The items provide a measure of a tendency towards psychiatric ill- health. Students indicate whether they have recently experienced specified symptoms such as getting pains in one's head; losing much sleep over worry; poor coping, being unable to manage or to keep oneself busy.
Physical Health .This utilised a so-called Physical Complaints Scale which comprised a list of 21 common ill-health symptoms or physical complaints. Respondents were asked to indicate how often during the year they had experienced each of them; for example, headaches, sore throats, stomach ache, mouth sores, diarrhoea, fainting, "thumping" in the chest and vomiting.
The results indicated that those boys and girls who reported high levels of peer victimisation in 1994 had comparatively high scores on the measure of poor physical health in 1997, and the result was statistically significant for each sex. It must be emphasised that the correlations between victimisation in 1997 and physical health in 1997 for each sex were NOT significant. It was not contemporary peer relations that appeared to be making the difference in the health of these mid-teen adolescents but seemingly how they had been treated three years previously by students when they first came to the school. It may be added that some other results in this study were gender-specific: For girls but not for boys peer victimisation in 1994 significantly predicted poor psychiatric health in 1997.
In every piece of research it seems possible to posit extraneous factors that may account for certain results. For example, it may be asked whether the relatively poor health of some senior students could not be explained as simply a continuation of poor health at an earlier stage. We did in fact find that girls who reported having relatively poor mental health in 1994 tended to have poor mental health in 1997 (there was no such continuity in boys' health). However when statistical controls for student health in Junior school were used in subsequent analyses, it was found that this health factor could not have accounted for the results that strongly suggested a causal status for peer victimisation.
Of course, further research is needed, especially more longitudinal research. We need to know, among other things, how styles of parenting affect both being victimised by other students at school and level of health. Some research has indicated that adolescents who feel over controlled at home by uncaring parents are more likely than others to be bullied at school and also to feel unhappy or depressed (Rigby and Cunningham, 1998). Further, we need to explore in more detail the role that positive peer relations at school can play in enhancing or protecting the health of adolescents. There is evidence from the South Australian studies that the perception of being supported by others at school can act in such a way as to protect a person against possible adverse health effects following repeated peer victimisation. Finally, it is evident that some students adopt more effective methods of coping with the experience of being bullied than others and this limits the negative effect it can have on their health.
SOME PRACTICAL IMPLICATIONS
Whether or not the recent South Australian research suggesting a causal connection between peer victimisation and poor health is confirmed by subsequent research, it now seems clear that in early adolescence being victimised repeatedly at school by peers is commonly associated with poor health. Hence, children who are victimised for whatever reason are more likely than others to need help to achieve or maintain good levels of personal well-being.
Secondly, the net effect of the studies reviewed in this article should be to encourage schools to seek ways in which levels of bullying can be decreased. Helping children to be more assertive and more able to defend themselves from peer aggression is one approach to the problem. But it should be recognised that there will always be some children who are more vulnerable than others, and that where children are victimised by groups of other students action on the part of individuals who are targeted is likely to be ineffective. Hence schools need to establish workable policies and procedures for dealing with bullying behaviour. Fortunately literature on what schools can do to counter bullying is becoming increasingly available (Rigby, 1996; Slee, 1996). In the light of what we now know about the effects of bullying, appropriate action by schools should be viewed as an urgent preventative health measure.
References
Boulton, M.J. and Smith, P.K. (1994). Bully/victim problems among middle school children: stability, self-perceived competence, and peer acceptance. British Journal of Developmental Psychology, 12, 315-329.
Goldberg, D. and Williams, P. (1991). The Users Guide to the General Health Questionnaire,
NFER, Nelson: UK.
Holmes, T.S. and Rahe, R.H. (1967). The Social Readjustment Rating Scale.
Journal of Psychosomatic Research, 11, 213 - 18.
Kochenderfer, B.J. and Ladd, G.W. (1996). Peer Victimisation: Cause or Consequence of School Maladjustment. Child Development, 67, 1305-1317.
Mynard, H. and Joseph, S. (1997). Bully/victim problems and their association with Eysenck's personality dimensions in 8 to 13 year-olds. British Journal of Educational Psychology, 67, 51-54.
Olweus (1978). Aggression in schools. Bullies and Whipping Boys. Washington D.C.: Hemisphere Press (Wiley).
Olweus, D. (1993). Bullying at school. Oxford, Blackwell.
O'Moore, A.M. and Hillery, B. (1991). What do teachers need to know? In M. Elliott (ed.) Bullying: A practical guide to coping in schools. Harlow, UK: David Fulton.
Rigby, K. (1994). Family Influence, Peer-Relations and Health Effects among School children. In K. Oxenberry, K. Rigby, and P.T. Slee (Eds.) Children's Peer Relations Conference Proceedings, Adelaide: The Institute of Social Research, University of South Australia, pp 294-304.
Rigby, K. (1996). Bullying in Australian schools - and what to do about it. Melbourne: ACER.
Rigby, K. (1997a). What children tell us about bullying in schools. Children Australia, 22, 2, 28-34.
Rigby, K. (1997b). Can adverse peer-relations at school drive children to suicide ?
Proceedings of the International School Psychology XXth Annual Colloquium,
Melbourne, July, 246 - 253.
Rigby, K. (1997c) The relationship between reported health and involvement in bully/victim problems at school among Australian adolescent students (unpublished paper)
Rigby, K. and Cunningham, R. (1998). The influence of relations with parents on the peer victimisation of Australian adolescents at school. Submitted for publication.
Rigby, K. and Slee, P.T. (1993). Dimensions of interpersonal relating among Australian school children and their implications for psychological well-being. Journal of Social Psychology, 133(1), 33-42.
Rigby, K. and Slee, P.T. (1998). Change and continuity in student bully/victim behaviours and associated health outcomes. Unpublished paper.
Sharp, S. (1995). How much does bullying hurt? The effects of bullying on the personal well-being and educational progress of secondary aged students. Educational and Child Psychology, 12, 81-88.
Slee. P.T. (1996) THE PEACE PACK: Reducing bullying in our schools. Flinders University : Adelaide.
Williams, K., Chambers, M., Logan, S. & Robinson, D. (1996). Association of common health symptoms with bullying in primary school children. British Medical Journal, 313: 17 - 19.
Zubrick, S.R., Silburn, S.R., Gurrin, L., Teoh, H., Shepherd, C., Carlton, J. and Lawrence, D. (1997). Western Australian Child Health Survey: Education, Health and Competence. Perth, Western Australia: Australian Bureau of Statistics and Institute for Child Health Research.