what is your research study all about bullying

• Research article
• Open access
• 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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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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ORIGINAL RESEARCH article

Understanding alternative bullying perspectives through research engagement with young people.

• School of Education and Social Care, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom

Bullying research has traditionally been dominated by largescale cohort studies focusing on the personality traits of bullies and victims. These studies focus on bullying prevalence, risk and protective factors, and negative outcomes. A limitation of this approach is that it does not explain why bullying happens. Qualitative research can help shed light on these factors. This paper discusses the findings from four mainly qualitative research projects including a systematic review and three empirical studies involving young people to various degrees within the research process as respondents, co-researchers and commissioners of research. Much quantitative research suggests that young people are a homogenous group and through the use of surveys and other large scale methods, generalizations can be drawn about how bullying is understood and how it can be dealt with. Findings from the studies presented in this paper, add to our understanding that young people appear particularly concerned about the role of wider contextual and relational factors in deciding if bullying has happened. These studies underscore the relational aspects of definitions of bullying and, how the dynamics of young people’s friendships can shift what is understood as bullying or not. Moreover, to appreciate the relational and social contexts underpinning bullying behaviors, adults and young people need to work together on bullying agendas and engage with multiple definitions, effects and forms of support. Qualitative methodologies, in particular participatory research opens up the complexities of young lives and enables these insights to come to the fore. Through this approach, effective supports can be designed based on what young people want and need rather than those interpreted as supportive through adult understanding.

Introduction

Research on school bullying has developed rapidly since the 1970s. Originating in social and psychological research in Norway, Sweden, and Finland, this body of research largely focusses on individualized personality traits of perpetrators and victims ( Olweus, 1995 ). Global interest in this phenomenon subsequently spread and bullying research began in the United Kingdom, Australia, and the United States ( Griffin and Gross, 2004 ). Usually quantitative in nature, many studies examine bullying prevalence, risk and protective factors, and negative outcomes ( Patton et al., 2017 ). Whilst quantitative research collates key demographic information to show variations in bullying behaviors and tendencies, this dominant bullying literature fails to explain why bullying happens. Nor does it attempt to understand the wider social contexts in which bullying occurs. Qualitative research on the other hand, in particular participatory research, can help shed light on these factors by highlighting the complexities of the contextual and relational aspects of bullying and the particular challenges associated with addressing it. Patton et al. (2017) in their systematic review of qualitative methods used in bullying research, found that the use of such methods can enhance academic and practitioner understanding of bullying.

In this paper, I draw on four bullying studies; one systematic review of both quantitative and qualitative research ( O’Brien, 2009 ) and three empirical qualitative studies ( O’Brien and Moules, 2010 ; O’Brien, 2016 , 2017 ) (see Table 1 below). I discuss how participatory research methodologies, to varying degrees, were used to facilitate bullying knowledge production among teams of young people and adults. Young people in these presented studies were consequently involved in the research process along a continuum of involvement ( Bragg and Fielding, 2005 ). To the far left of the continuum, young people involved in research are referred to as “active respondents” and their data informs teacher practice. To the middle of the continuum sit “students as co-researchers” who work with teachers to explore an issue which has been identified by that teacher. Finally to the right, sit “students as researchers” who conduct their own research with support from teachers. Moving from left to right of the continuum shows a shift in power dynamics between young people and adults where a partnership develops. Young people are therefore recognized as equal to adults in terms of what they can bring to the project from their own unique perspective, that of being a young person now.

Table 1. The studies.

In this paper, I advocate for the active involvement of young people in the research process in order to enhance bullying knowledge. Traditional quantitative studies have a tendency to homogenize young people by suggesting similarity in thinking about what constitutes bullying. However, qualitative studies have demonstrated that regardless of variables, young people understand bullying in different ways so there is a need for further research that starts from these perspectives and focusses on issues that young people deem important. Consequently, participatory research allows for the stories of the collective to emerge without losing the stories of the individual, a task not enabled through quantitative approaches.

What Is Bullying?

Researching school bullying has been problematic and is partly related to the difficulty in defining it ( Espelage, 2018 ). Broadly speaking, bullying is recognized as aggressive, repeated, intentional behavior involving an imbalance of power aimed toward an individual or group of individuals who cannot easily defend themselves ( Vaillancourt et al., 2008 ). In more recent times, “traditional” bullying behaviors have been extended to include cyber-bullying, involving the use of the internet and mobile-phones ( Espelage, 2018 ). Disagreements have been noted in the literature about how bullying is defined by researchers linked to subject discipline and culture. Some researchers for example, disagree about the inclusion or not of repetition in definitions ( Griffin and Gross, 2004 ) and these disagreements have had an impact on interpreting findings and prevalence rates. However, evidence further suggests that young people also view bullying in different ways ( Guerin and Hennessy, 2002 ; Cuadrado-Gordillo, 2012 ; Eriksen, 2018 ). Vaillancourt et al. (2008) explored differences between researchers and young people’s definitions of bullying, and found that children’s definitions were usually spontaneous, and did not always encompass the elements of repetition, power imbalance and intent. They concluded, that children need to be provided with a bullying definition so similarities and comparisons can be drawn. In contrast, Huang and Cornell (2015) found no evidence that the inclusion of a definition effected prevalence rates. Their findings, they suggest, indicate that young people use their own perceptions of bullying when answering self-report questionnaires and they are not influenced by an imposed definition.

Nevertheless, differences in children and young people’s bullying definitions are evident in the research literature and have been explained by recourse to age and stage of development ( Smith et al., 2002 ) and their assumed lack of understanding about what constitutes bullying ( Boulton and Flemington, 1996 ). Naylor et al. (2001) for example, found that younger children think similarly in their definitions of bullying, while Smith et al. (2002) found that 8 year olds did not distinguish as clearly between different forms of behavioral aggression as 14 year olds. Methodological limitations associated with understanding bullying have been identified by Forsberg et al. (2018) and Maunder and Crafter (2018) . These authors postulate that quantitative approaches, although providing crucial insights in understanding bullying, are reliant on pre-defined variables, which can shield some of the complexities that qualitative designs can unravel, as individual experiences of bullying are brought to the fore. Indeed, La Fontaine (1991) suggests that unlike standard self-report questionnaires and other quantitative methods used to collect bullying data, analyzing qualitative data such as those collected from a helpline, enables the voice of young people to be heard and consequently empowers adults to understand bullying on their terms rather than relying solely on interpretations and perceptions of adults. Moore and Maclean (2012) collected survey, as well as interview and focus group data, on victimization occurring on the journey to and from school. They found that what young people determined as victimization varied and was influenced by a multifaceted array of circumstances, some of which adults were unaware of. Context for example, played an important role where certain behaviors in one situation could be regarded as victimization while in another they were not. Specific behaviors including ignoring an individual was particularly hurtful and supporting a friend who was the subject of victimization could lead to their own victimization.

Lee (2006) suggests that some bullying research does not reflect individual experiences, and are thus difficult for participants to relate to. Canty et al. (2016) reiterates this and suggests that when researchers provide young people with bullying definitions in which to position their own experiences, this can mask some of the complexities that the research intends to uncover. Such approaches result in an oversight into the socially constructed and individual experiences of bullying ( Eriksen, 2018 ). Griffin and Gross (2004) further argue that when researchers use vague or ambiguous definitions an “overclassification of children as bullies or victims” (p. 381) ensues. Consequently, quantitative research does not consider children as reliable in interpreting their own lived experiences and therefore some of the interactions they consider as bullying, that do not fit within the conventional definitions, are concealed. This approach favors the adult definition of bullying regarding it as “more reliable” than the definitions of children and young people Canty et al. (2016) . The perceived “seriousness” of bullying has also been explored. Overall, young people and adults are more likely to consider direct bullying (face-to-face actions including hitting, threatening and calling names) as “more serious” than indirect bullying (rumor spreading, social exclusion, forcing others to do something they do not want to do) ( Maunder et al., 2010 ; Skrzypiec et al., 2011 ). This perception of “seriousness,” alongside ambiguous definitions of bullying, has further implications for reporting it. Despite the advice given to young people to report incidents of school bullying ( Moore and Maclean, 2012 ), the literature suggests that many are reluctant to do so ( deLara, 2012 ; Moore and Maclean, 2012 ).

Several factors have been highlighted as to why young people are reluctant to report bullying ( Black et al., 2010 ). deLara (2012) , found apprehension in reporting bullying to teachers due to the fear that they will either not do enough or too much and inadvertently make the situation worse, or fear that teachers will not believe young people. Research also shows that young people are reluctant to tell their parents about bullying due to perceived over-reaction and fear that the bullying will be reported to their school ( deLara, 2012 ; Moore and Maclean, 2012 ). Oliver and Candappa (2007) suggest that young people are more likely to confide in their friends than adults (see also Moore and Maclean, 2012 ; Allen, 2014 ). However, if young people believe they are being bullied, but are unable to recognize their experiences within a predefined definition of bullying, this is likely to impact on their ability to report it.

Research from psychology, sociology, education and other disciplines, utilizing both quantitative and qualitative approaches, have enabled the generation of bullying knowledge to date. However, in order to understand why bullying happens and how it is influenced by wider social constructs there is a need for further qualitative studies, which hear directly from children and young people themselves. The next section of this paper discusses the theoretical underpinnings of this paper, which recognizes that young people are active agents in generating new bullying knowledge alongside adults.

Theoretical Underpinnings – Hearing From Children and Young People

The sociology of childhood ( James, 2007 ; Tisdall and Punch, 2012 ) and children’s rights agenda more broadly ( United Nations Convention on the Rights of the Child, 1989 ) have offered new understandings and methods for research which recognize children and young people as active agents and experts on their own lives. From this perspective, research is conducted with rather than on children and young people ( Kellett, 2010 ).

Participatory methodologies have proven particularly useful for involving young people in research as co-researchers (see for example O’Brien and Moules, 2007 ; Stoudt, 2009 ; Kellett, 2010 ; Spears et al., 2016 ). This process of enquiry actively involves those normally being studied in research activities. Previously, “traditional” researchers devalued the experiences of research participants arguing that due to their distance from them, they themselves are better equipped to interpret these experiences ( Beresford, 2006 ). However, Beresford (2006) suggests that the shorter the distance between direct experience and interpretation, the less distorted and inaccurate the resulting knowledge is likely to be. Jones (2004) further advocates that when young people’s voices are absent from research about them the research is incomplete. Certainly Spears et al. (2016) , adopted this approach in their study with the Young and Well Cooperative Research Centre (CRC) in Australia. Young people played an active role within a multidisciplinary team alongside researchers, practitioners and policymakers to co-create and co-evaluate the learning from four marketing campaigns for youth wellbeing through participatory research. Through this methodological approach, findings show that young people were able to reconceptualize mental health and wellbeing from their own perspectives as well as share their lived experiences with others ( Spears et al., 2016 ). Bland and Atweh (2007) , Ozer and Wright (2012) , highlight the benefits afforded to young people through this process, including participating in dialog with decision-makers and bringing aspects of teaching and learning to their attention.

Against this background, data presented for this paper represents findings from four studies underpinned by the ethos that bullying is socially constructed and is best understood by exploring the context to which it occurs ( Schott and Sondergaard, 2014 ; Eriksen, 2018 ). This socially constructed view focusses on the evolving positions within young people’s groups, and argues that within a bullying situation sometimes a young person is the bully, sometimes the victim and sometimes the bystander/witness, which contrasts the traditional view of bullying ( Schott and Sondergaard, 2014 ). The focus therefore is on group relationships and dynamics. For that reason, Horton (2011) proposes that if bullying is an extensive problem including many young people, then focusing entirely on personality traits will not generate new bullying knowledge and will be problematic in terms of interventions. It is important to acknowledge that this change in focus and view of bullying and how it is manifested in groups, does not negate the individual experiences of bullying rather the focus shifts to the process of being accepted, or not, by the group ( Schott and Sondergaard, 2014 ).

The Studies

This section provides a broad overview of the four included studies underpinned by participatory methodologies. Table 1 presents the details of each study. Young people were involved in the research process as respondents, co-researchers and commissioners of research, along a continuum as identified by Bragg and Fielding (2005) . This ranged from “active respondents” to the left of the continuum, “students as co-researchers” in the middle and “students as researchers” to the right of the continuum. Young people were therefore recognized as equal to adults in terms of what they can bring to the project from their own unique perspectives ( Bradbury-Jones et al., 2018 ).

A key finding from study one ( O’Brien, 2009 ) was the lack of voice afforded to young people through the research process and can be seen to reflect the far left of Bragg and Fielding (2005) continuum, as young people were not directly involved as “active respondents” but their views were included in secondary data analysis and informed the studies that followed. For example, the quantitative studies used an agreed academic definition of bullying which may or may not have influenced how young participants defined bullying within the studies. On the other hand, the qualitative study involved a group of students in deciding which questions to ask of the research participants and in interpreting the findings.

In contrast, study two ( O’Brien and Moules, 2010 ) was commissioned and led by a group of young people called PEAR (Public health, Education, Awareness, Researchers), who were established to advise on public health research in England. PEAR members were based in two large English cities and comprised 20 young people aged between 13 and 20 years. The premise of the study was that PEAR members wanted to commission research into cyber bullying and the effects this has on mental health from the perspectives of young people rather than adult perspectives. This project was innovative as young people commissioned the research and participated as researchers ( Davey, 2011 ) and can be seen to reflect the middle “students as co-researchers” as well as moving toward to right “students as researchers” of Bragg and Fielding (2005) continuum. Although the young people did not carry out the day-to-day work on the project, they were responsible for leading and shaping it. More importantly, the research topic and focus were decided with young people and adults together.

Study three ( O’Brien, 2016 ) involved five self-selecting students from an independent day and boarding school who worked with me to answer this question: What do young people in this independent day and boarding school view as the core issue of bullying in the school and how do they want to address this? These students called themselves R4U (Research for You) with the slogan researching for life without fear . Three cycles of Participatory Action Research (PAR) ensued, where decision making about direction of the research, including methods, analysis and dissemination of findings were made by the research team. As current students of the school, R4U had a unique “insider knowledge” that complemented my position as the “academic researcher.” By working together to generate understanding about bullying at the school, the findings thus reflected this diversity in knowledge. As the project evolved so too did the involvement of the young researchers and my knowledge as the “outsider” (see O’Brien et al., 2018a for further details). Similar to study two, this project is situated between the middle: “students as co-researchers” and the right: “students as researchers” of Bragg and Fielding (2005) continuum.

Study four ( O’Brien, 2017 ) was small-scale and involved interviewing four young people who were receiving support from a charity providing therapeutic and educational support to young people who self-exclude from school due to anxiety, as a result of bullying. Self-exclusion, for the purposes of this study, means that a young person has made a decision not to go to school. It is different from “being excluded” or “truanting” because these young people do not feel safe at school and are therefore too anxious to attend. Little is known about the experiences of young people who self-exclude due to bullying and this study helped to unravel some of these issues. This study reflects the left of Bragg and Fielding (2005) continuum where the young people were involved as “active respondents” in informing adult understanding of the issue.

A variety of research methods were used across the four studies including questionnaires, interviews and focus groups (see Table 1 for more details). In studies two and three, young researchers were fundamental in deciding the types of questions to be asked, where they were asked and who we asked. In study three the young researchers conducted their own peer-led interviews. The diversity of methods used across the studies are a strength for this paper. An over-reliance on one method is not portrayed and the methods used reflected the requirements of the individual studies.

Informed Consent

Voluntary positive agreement to participate in research is referred to as “consent” while “assent,” refers to a person’s compliance to participate ( Coyne, 2010 ). The difference in these terms are normally used to distinguish the “legal competency of children over and under 16 years in relation to research.” ( Coyne, 2010 , 228). In England, children have a legal right to consent so therefore assent is non-applicable ( Coyne, 2010 ). However, there are still tensions surrounding the ability of children and young people under the age of 18 years to consent in research which are related to their vulnerability, age and stage of development ( Lambert and Glacken, 2011 ). The research in the three empirical studies (two, three and four) started from the premise that all young participants were competent to consent to participate and took the approach of Coyne (2010) who argues that parental/carer consent is not always necessary in social research. University Research Ethics Committees (RECs) are nonetheless usually unfamiliar with the theoretical underpinnings that children are viewed as social actors and generally able to consent for themselves ( Lambert and Glacken, 2011 ; Fox, 2013 ; Parsons et al., 2015 ).

In order to ensure the young people in these reported studies were fully informed of the intentions of each project and to adhere to ethical principles, age appropriate participant information sheets were provided to all participants detailing each study’s requirements. Young people were then asked to provide their own consent by signing a consent form, any questions they had about the studies were discussed. Information sheets were made available to parents in studies three and four. In study two, the parents of young people participating in the focus groups were informed of the study through the organizations used to recruit the young people. My full contact details were provided on these sheets so parents/carers could address any queries they had about the project if they wished. When young people participated in the online questionnaire (study two) we did not know who they were so could not provide separate information to parents. Consequently, all participants were given the opportunity to participate in the research without the consent of their parents/carers unless they were deemed incompetent to consent. In this case the onus was on the adult (parent or carer for example) to prove incompetency ( Alderson, 2007 ). Favorable ethical approval, including approval for the above consent procedures, was granted by the Faculty Research Ethics Committee at Anglia Ruskin University.

In the next section I provide a synthesis of the findings across the four studies before discussing how participatory research with young people can offer new understandings of bullying and its impacts on young people.

Although each study was designed to answer specific bullying research questions, the following key themes cut across all four studies 1 :

• Bullying definitions

◦ Behaviors

• Impact of bullying on victim

• Reporting bullying

Bullying Definitions

Young people had various understandings about what they considered bullying to be. Overall, participants agreed that aggressive direct behaviors, mainly focusing on physical aggression, constituted bullying:

“…if someone is physically hurt then that is bullying straight away.” (Female, study 3).

“I think [cyber-bullying is] not as bad because with verbal or physical, you are more likely to come in contact with your attacker regularly, and that can be disturbing. However, with cyber-bullying it is virtual so you can find ways to avoid the person.” (Female, study 2).

Name-calling was an ambiguous concept, young people generally believed that in isolation name-calling might not be bullying behavior or it could be interpreted as “joking” or “banter”:

“I never really see any, a bit of name calling and taking the mick but nothing ever serious.” (Male, study 3).

The concept of “banter” or “joking” was explored in study three as a result of the participatory design. Young people suggested “banter” involves:

“…a personal joke or group banter has no intention to harm another, it is merely playful jokes.” (Female, study 3).

However, underpinning this understanding of “banter” was the importance of intentionality:

“Banter saying things bad as a joke and everyone knows it is a joke.” (Male, study 3).

“Banter” was thus contentious when perception and reception were ambiguous. In some cases, “banter” was considered “normal behavior”:

“…we’ve just been joking about, but it’s never been anything harsh it’s just been like having a joke…” (Male, study 3).

The same view was evident in relation to cyber-bullying. Some participants were rather dismissive of this approach suggesting that it did not exist:

“I don’t really think it exists. If you’re being cyber-“bullied” then there is something wrong with you- it is insanely easy to avoid, by blocking people and so on. Perhaps it consists of people insulting you online?” (Male, study 2).

When young people considered additional factors added to name calling such as the type of name-calling, or aspects of repetition or intention, then a different view was apparent.

“…but it has to be constant it can’t be a single time because that always happens.” (Male, study 3).

Likewise with words used on social media, young people considered intentionality in their consideration of whether particular behaviors were bullying, highlighting important nuances in how bullying is conceptualized:

“Some people they don’t want to sound cruel but because maybe if you don’t put a smiley face on it, it might seem cruel when sometimes you don’t mean it.” (Female, study 2).

Study one also found that young people were more likely to discuss sexist or racist bullying in interviews or focus groups but this information was scarce in the questionnaire data. This is possibly as a result of how the questions were framed and the researchers’ perspectives informing the questions.

Evident across the four studies was the understanding young people had about the effects of continuous name-calling on victims:

“…you can take one comment, you can just like almost brush it off, but if you keep on being bullied and bullied and bullied then you might kind of think, hang on a minute, they’ve taken it a step too far, like it’s actually become more personal, whereas just like a cheeky comment between friends it’s become something that’s more serious and more personal and more annoying or hurtful to someone.” (Female, study 3).

“Cyber-bullying is basically still verbal bullying and is definitely psychological bullying. Any bullying is psychological though, really. And any bullying is going to be harmful.” (Female, study 2).

Aspects of indirect bullying (social exclusion) were features of studies one and three. For the most part, the research reviewed in study one found that as young people got older they were less likely to consider characteristics of social exclusion in their definitions of bullying. In study three, when discussing the school’s anti-bullying policy, study participants raised questions about “ isolating a student from a friendship group .” Some contested this statement as a form of bullying:

“…. there is avoiding, as in, not actively playing a role in trying to be friends which I don’t really see as bullying I see this as just not getting someone to join your friendship group. Whereas if you were actually leaving him out and rejecting him if he tries to be friends then I think I would see that as malicious and bullying.” (Male, study 3).

“Isolating a student from a friendship group – I believe there are various reasons for which a student can be isolated from a group – including by choice.” (Female, study 3).

Cyber-bullying was explored in detail in study two but less so in the other three studies. Most study two participants considered that cyber-bullying was just as harmful, or in some cases worse than, ‘traditional’ bullying due to the use of similar forms of “harassment,” “antagonizing,” “tormenting,” and ‘threatening’ through online platforms. Some young people believed that the physical distance between the victim and the bully is an important aspect of cyber-bullying:

“I think it’s worse because people find it easier to abuse someone when not face to face.” (Male, study 2).

“I think it could be worse, because lots of other people can get involved, whereas when it’s physical bullying it’s normally just between one or two or a smaller group, things could escalate too because especially Facebook, they’ve got potential to escalate.” (Female, study 2).

Other participants in study two spoke about bullying at school which transfers to an online platform highlighting no “escape” for some. In addition, it was made clearer that some young people considered distancing in relation to bullying and how this influences perceptions of severity:

“…when there’s an argument it can continue when you’re not at school or whatever and they can continue it over Facebook and everyone can see it then other people get involved.” (Female, study 2).

“I was cyber-bullied on Facebook, because someone put several hurtful comments in response to my status updates and profile pictures. This actually was extended into school by the bully…” (Male, study 2).

Impact of Bullying on Victim

Although bullying behaviors were a primary consideration of young people’s understanding of bullying, many considered the consequences associated with bullying and in particular, the impact on mental health. In these examples, the specifics of the bullying event were irrelevant to young people and the focus was on how the behavior was received by the recipient.

In study two, young people divulged how cyber-bullying had adversely affected their ability to go to school and to socialize outside school. Indeed some young people reported the affects it had on their confidence and self-esteem:

“I developed anorexia nervosa. Although not the single cause of my illness, bullying greatly contributed to my low self-esteem which led to becoming ill.” (Female, study 2).

“It hurts people’s feelings and can even lead to committing suicide….” (Female, study 2).

Across the studies, young people who had been bullied themselves shared their individual experiences:

“….you feel insecure and it just builds up and builds up and then in the end you have no self-confidence.” (Female, study 2).

“…it was an everyday thing I just couldn’t take it and it was causing me a lot of anxiety.” (Male, study 4).

“I am different to everyone in my class …. I couldn’t take it no more I was upset all the time and it made me feel anxious and I wasn’t sleeping but spent all my time in bed being sad and unhappy.” (Male, study 4).

Young people who had not experienced bullying themselves agreed that the impact it had on a person was a large determiner of whether bullying had happened:

“When your self-confidence is severely affected and you become shy. Also when you start believing what the bullies are saying about you and start to doubt yourself.” (Female, study 3).

“…it makes the victim feel bad about themselves which mostly leads to depression and sadness.” (Male, study 2).

Further evidence around the impact of bullying was apparent in the data in terms of how relational aspects can affect perceived severity. In the case of cyber-bullying, young people suggested a sense of detachment because the bullying takes place online. Consequently, as the relational element is removed bullying becomes easier to execute:

“…because people don’t have to face them over a computer so it’s so much easier. It’s so much quicker as well cos on something like Facebook it’s not just you, you can get everyone on Facebook to help you bully that person.” (Female, study 2).

“Due to technology being cheaper, it is easier for young people to bully people in this way because they don’t believe they can be tracked.” (Male, study 2).

“The effects are the same and often the bullying can be worse as the perpetrator is unknown or can disguise their identity. Away from the eyes of teachers etc., more can be done without anyone knowing.” (Female, study 2).

Relational aspects of bullying were further highlighted with regards to how “banter” was understood, particularly with in-group bullying and how the same example can either be seen as “banter” or bullying depending on the nature of the relationship:

“…we’ve just been joking about, but it’s never been anything harsh it’s just been like having a joke. well, I haven’t done it but I’ve been in a crowd where people do it, so I don’t want to get involved just in case it started an argument.” (Female, study 3).

“But it also depends…who your groups with, for example, if I spoke to my friends from [School]… I wouldn’t like use taboo language with them because to them it may seem inappropriate and probably a bit shocked, but if I was with my friends outside of school we use taboo language, we’ll be ourselves and we’ll be comfortable with it, and if a stranger walked past and heard us obviously they’d be thinking that we’re being bullied ourselves.” (Female, study 3).

Furthermore, how individuals are perceived by others tended to influence whether they were believed or not. In study four for example, participants suggested that who the bullies were within the school might have impacted how complaints were acted upon by school officials:

“When I went to the school about it, the students said I had attacked them – all eight of them! I just realized that no one believes me….” (Female, study 4).

While in study three, a characteristic of bullying was the influence the aggressor has over the victim:

“When the victim starts to feel in danger or start to fear the other person. Consequently he or she tries to avoid the bad guy (or girl!)” (Male, study 3).

These relational and contextual issues also influenced a young person’s ability to report bullying.

Reporting Bullying

Young people were more likely to report bullying when they considered it was ‘serious’ enough. Just under half of participants in study two sought emotional/practical support if they worried about, or were affected by cyber-bullying, with most talking to their parents. In study three, young people were less likely to seek support but when they did, most went to their teachers. In study four, all participants reported bullying in school where they did not feel supported.

Fear of making the bullying worse was captured across the studies as a reason for not reporting it:

“I’m scared that if I tell then the bullying will still go on and they will do more.” (Female, study 3).

“The bully might bully you if he finds out.” (Male, study 3).

Being able to deal with the incident themselves was also a reason for non-reporting:

“…it’s embarrassing and not necessary, my friends help me through it, adults never seem to understand.” (Female, study 2).

“I don’t tend to talk to anyone about it, I just keep it to myself and obviously that’s the worst thing you should ever do, you should never keep it to yourself, because I regret keeping it to myself to be honest….” (Female, study 3).

“…but I think I’d deal with it myself ‘cos. I was quite insecure but now I’m quite secure with myself, so I’ll sort it out myself. I think it’s just over time I’ve just sort of hardened to it.” (Male, study 3).

Most young people seeking support for bullying said they spoke to an adult but the helpfulness of this support varied. This finding is important for understanding relationships between young people and adults. Those who felt supported by their teachers for example, suggested that they took the time to listen and understood what they were telling them. They also reassured young people who in turn believed that the adult they confided in would know what to do:

“So I think the best teacher to talk to is [Miss A] and even though people are scared of her I would recommend it, because she’s a good listener and she can sense when you don’t want to talk about something, whereas the other teachers force it out of you.” (Female, study 3).

“My school has had assemblies about cyber-bullying and ways you can stop it or you can report it anonymously…. you can write your name or you can’t, it’s all up to YOU.” (Male, study 2).

Others however had a negative experience of reporting bullying and a number of reasons were provided as to why. Firstly, young people stated that adults did not believe them which made the bullying worse on some level:

“I went to the teachers a couple of times but, no, I don’t think they could do anything. I did sort of go three times and it still kept on going, so I just had to sort of deal with it and I sort of took it on the cheek….” (Male, study 3).

Secondly, young people suggested that adults did not always listen to their concerns, or in some cases did not take their concerns seriously enough:

“…I had had a really bad day with the girls so I came out and I explained all this to my head of year and how it was affecting me but instead of supporting me he put me straight into isolation.” (Male, study 4).

“I could understand them thinking I maybe got the wrong end of the stick with one incident but this was 18 months of me constantly reporting different incidents.” (Female, study 4).

“If cyber-bullying is brought to our school’s attention, usually, they expect printed proof of the situation and will take it into their own hand depending on its seriousness. However this is usually a couple of detentions. And it’s just not enough.” (Female, study 2).

Finally, some young people suggested that teachers did not always know what to do when bullying concerns were raised and consequently punished those making the complaint:

“I think I would have offered support instead of punishment to someone who was suffering with anxiety. I wouldn’t have seen anxiety as bad behavior I think that’s quite ignorant but they saw it as bad behavior.” (Male, study 4).

It is worth reiterating, that the majority of young people across the studies did not report bullying to anybody , which further underscores the contextual issues underpinning bullying and its role in enabling or disabling bullying behaviors. Some considered it was “pointless” reporting the bullying and others feared the situation would be made worse if they did:

“My school hide and say that bullying doesn’t go on cos they don’t wanna look bad for Ofsted.” (Male, study 2).

“My school is oblivious to anything that happens, many things against school rules happen beneath their eyes but they either refuse to acknowledge it or are just not paying attention so we must suffer.” (Female, study 2).

“That’s why I find that when you get bullied you’re scared of telling because either, in most cases the teacher will – oh yeah, yeah, don’t worry, we’ll sort it out and then they don’t tend to, and then they get bullied more for it.” (Female, study 3).

Young people were concerned that reporting bullying would have a negative impact on their friendship groups. Some were anxious about disrupting the status quo within:

“I think everyone would talk about me behind my back and say I was mean and everyone would hate me.” (Female, study 3).

Others expressed concern about the potential vulnerability they were likely to experience if they raised concerns of bullying:

“I was worried it might affect my other friendships.”(Boy, study 2).

“I’m scared that if I tell, then the bullying will still go on and they will do more.” (Female, study 3).

“….because they might tell off the bullies and then the bullies will like get back at you.” (Female, study 3).

These findings underscore the importance of contextual and relational factors in understanding bullying from the perspectives of young people and how these factors influence a young person’s ability or willingness to report bullying.

Finally one young person who had self-excluded from school due to severe bullying suggested that schools:

“…need to be looking out for their students’ mental wellbeing – not only be there to teach them but to support and mentor them. Keep them safe really… I missed out on about three years of socializing outside of school because I just couldn’t do it. I think it’s important that students are encouraged to stand up for each other.” (Female, study 4).

The studies presented in this paper illustrate the multitude of perceptions underpinning young people’s understandings of what constitutes bullying, both in terms of the behavior and also the impact that this behavior has on an individual. In turn, the ambiguity of what constitutes bullying had an impact on a young person’s ability to seek support. Discrepancies in bullying perceptions within and between young people’s groups are shown, highlighting the fluid and changing roles that occur within a bullying situation. Findings from quantitative studies have demonstrated the differing perceptions of bullying by adults and young people (see for example Smith et al., 2002 ; Vaillancourt et al., 2008 ; Maunder et al., 2010 ; Cuadrado-Gordillo, 2012 ). However, by combining findings from participatory research, new understandings of the relational and contextual factors important to young people come to the fore.

Young people participating in these four studies had unique knowledge and experiences of bullying and the social interactions of other young people in their schools and wider friendship groups. The underpinning participatory design enabled me to work alongside young people to analyze and understand their unique perspectives of bullying in more detail. The research teams were therefore able to construct meaning together, based not entirely on our own assumptions and ideologies, but including the viewpoint of the wider research participant group ( Thomson and Gunter, 2008 ). Together, through the process of co-constructing bullying knowledge, we were able to build on what is already known in this field and contribute to the view that bullying is socially constructed through the experiences of young people and the groups they occupy ( Schott and Sondergaard, 2014 ).

With regards to understanding what bullying is, the findings from these studies corroborate those of the wider literature from both paradigms of inquiry (for example Naylor et al., 2001 ; Canty et al., 2016 ); that being the discrepancies in definitions between adults and young people and also between young people themselves. Yet, findings here suggest that young people’s bullying definitions are contextually and relationally contingent. With the exception of physical bullying, young people did not differentiate between direct or indirect behaviors, instead they tended to agree that other contextual and relational factors played a role in deciding if particular behaviors were bullying (or not). The participatory research design enabled reflection and further investigation of the ideas that were particularly important to young people such as repetition and intentionality. Repetition was generally seen as being indicative of bullying being “serious,” and therefore more likely to be reported, and without repetition, a level of normality was perceived. This finding contradicts some work on bullying definitions, Cuadrado-Gordillo (2012) for example found that regardless of the role played by young people in a bullying episode (victim, aggressor or witness), the criteria of ‘repetition’ was not important in how they defined bullying.

Relational factors underpinning young people’s perception of bullying and indeed it’s “seriousness” were further reflected in their willingness or otherwise to report it. Fear of disrupting the status quo of the wider friendship group, potentially leading to their own exclusion from the group, was raised as a concern by young people. Some were concerned their friends would not support them if they reported bullying, while others feared further retaliation as a result. Friendship groups have been identified as a source of support for those who have experienced bullying and as a protective factor against further bullying ( Allen, 2014 ). Although participants did not suggest their friendship groups are unsupportive it is possible that group dynamics underscore seeking (or not) support for bullying. Other literature has described such practices as evidence of a power imbalance ( Olweus, 1995 ; Cuadrado-Gordillo, 2012 ) but young people in these studies did not describe these unequal relationships in this way and instead focused on the outcomes and impacts of bullying. Indeed Cuadrado-Gordillo (2012) also found that young people in their quantitative study did not consider “power imbalance” in their understanding of bullying and were more likely to consider intention. This paper, however, underscores the relational aspects of definitions of bullying and, how the dynamics of young people’s friendships can shift what is understood as bullying or not. Without such nuances, some behaviors may be overlooked as bullying, whereas other more obvious behaviors draw further attention. This paper also shows that contextual issues such as support structures can shift how young people see bullying. Contextual factors were evident across the four studies through the recognition of bullying being enabled or disabled by institutional factors, including a school’s ability to respond appropriately to bullying concerns. Young people suggested that schools could be influenced by bullies, perceiving them as non-threatening and consequently not dealing appropriately with the situation. Indeed some young people reported that their schools placed the onus on them as victims to change, consequently placing the “blame” on victims instead. These findings raise questions about who young people feel able to confide in about bullying as well as issues around training and teacher preparedness to deal with bullying in schools. Evidenced in these four studies, is that young people feel somewhat disconnected from adults when they have bullying concerns. Those who did report bullying, identified particular individuals they trusted and knew would support them. Novick and Isaacs (2010) identified teachers who young people felt comfortable in approaching to report bullying and described them as “most active, engaged and responsive.” (p. 291). The bullying literature suggests that as young people get older they are more likely to confide in friends than adults ( Moore and Maclean, 2012 ; Allen, 2014 ). However, findings from this paper indicate that although fewer young people reported bullying, those who did confided in an adult. Young people have identified that a variety of supports are required to tackle bullying and that adults need to listen and work with them so nuanced bullying behaviors are not recognized as “normal” behaviors. Within the data presented in this paper, “banter” was portrayed as “normal” behavior. Young people did not specify what behaviors they regarded as “banter,” but suggested that when banter is repeated and intentional the lines are blurred about what is bullying and what is banter.

Exploring bullying nuances in this paper, was enhanced by the involvement of young people in the research process who had a unique “insider” perspective about what it is like to be a young person now and how bullying is currently affecting young people. In studies one and four, young people were “active respondents” ( Bragg and Fielding, 2005 ) and provided adults with their own unique perspectives on bullying. It could be argued that study one did not involve the participation of young people. However, this study informed the basis of the subsequent studies due to the discrepancies noted in the literature about how bullying is understood between adults and young people, as well as the lack of young people’s voice and opportunity to participate in the reviewed research. Accordingly, young people’s data as “active respondents” informed adult understanding and led to future work involving more active research engagement from other young people. Participation in study four provided an opportunity for young people to contribute to future participatory research based on lived experiences as well as informing policy makers of the effects bullying has on the lives of young people ( O’Brien, 2017 ). In studies two and three, young people were involved further along Bragg and Fielding (2005) continuum as “co-researchers” and “students as researchers” with these roles shifting and moving dependent on the context of the project at the time ( O’Brien et al., 2018a ). These young researchers brought unique knowledge to the projects ( Bradbury-Jones et al., 2018 ) that could not be accessed elsewhere. Perspectives offered by the young researchers supported adults in understanding more about traditional and cyber-bullying from their perspectives. Furthermore, this knowledge can be added to other, quantitative studies to further understand why bullying happens alongside bullying prevalence, risk and protective factors, and negative outcomes.

Findings from the four studies offer an alternative perspective to how bullying is understood by young people. Complexities in defining bullying have been further uncovered as understanding is informed by individual factors, as well as wider social and relational contexts ( Horton, 2011 ; Schott and Sondergaard, 2014 ). This has implications for the type of support young people require. This paper highlights how definitions of bullying shift in response to relational and contextual aspects deemed important to young people. Because of this, further nuances were uncovered through the research process itself as the respective studies showed discrepancies in bullying perceptions within and between young people’s groups.

These understandings can act as a starting point for young people and adults to collaborate in research which seeks to understand bullying and the context to which it occurs. Furthermore, such collaborations enable adults to theorize and understand the complexities associated with bullying from the perspective of those at the center. There is a need for additional participatory research projects involving such collaborations where adults and young people can learn from each other as well as combining findings from different methodologies to enable a more comprehensive picture of the issues for young people to emerge. Further research is needed to unravel the complexities of bullying among and between young people, specifically in relation to the contextual and relational factors underscoring perceptions of bullying.

Data Availability

The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.

Ethics Statement

Ethical approval was granted for all four studies from the Faculty of Health, Education, Medicine and Social Care at the Anglia Ruskin University. The research was conducted on the premise of Gillick competency meaning that young people (in these studies over the age of 12 years) could consent for themselves to participate. Parents/carers were aware the study was happening and received information sheets explaining the process.

Author Contributions

The author confirms being the sole contributor of this work and has approved it for publication.

These four studies were conducted at the Anglia Ruskin University. Study one was part of a wider masters degree funded by the Anglia Ruskin University, Study two was funded by a group of young people convened by the National Children’s Bureau with funding from the Wellcome Trust (United Kingdom). Study three was a wider Doctoral study funded by the Anglia Ruskin University and Study four was also funded by the Anglia Ruskin University.

Conflict of Interest Statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

I would like to thank Dr. Grace Spencer, Ruskin Fellow at the Anglia Ruskin University for providing the critical read of this manuscript and offering constructive feedback. I would also like to thank the two independent reviewers for their feedback on the drafts of this manuscript.

• ^ These findings focus on perceptions and data from the young people in the four studies. For a full discussion on adult perceptions please refer to the individual studies.

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Keywords : bullying, young people, participatory research, social constructionism, young people as researchers, collaboration, bullying supports

Citation: O’Brien N (2019) Understanding Alternative Bullying Perspectives Through Research Engagement With Young People. Front. Psychol. 10:1984. doi: 10.3389/fpsyg.2019.01984

Received: 28 February 2019; Accepted: 13 August 2019; Published: 28 August 2019.

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Copyright © 2019 O’Brien. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Niamh O’Brien, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Continuing Education Activity

Bullying is a serious and widespread global problem with detrimental consequences for the physical and mental well-being of children. It is a repeated and deliberate pattern of aggressive or hurtful behavior targeting individuals perceived as less powerful. Bullying manifests in various forms, such as physical, verbal, social/relational, and cyberbullying, each with unique characteristics. Vulnerable youth at greater risk of being bullied are individuals who are perceived as "different,"  including those belonging to racial and ethnic minorities, immigrants, refugees, individuals with notable physical features or disabilities, and younger and defenseless children.

Healthcare professionals are uniquely positioned to identify and prevent bullying and intervene to mitigate its mental and physical health consequences. This activity reviews issues of particular importance to clinicians. It gives them practical tips to increase their awareness of bullying, enabling early recognition and effective management of this complex issue. Bullying is a problem that affects both the victims and the perpetrators, and this course equips learners with the knowledge and skills to positively impact the lives of the youth it affects.

Objectives:

• Identify signs and symptoms of bullying behavior, recognizing overt and subtle indications of victimization.
• Differentiate between various forms of bullying, including physical, verbal, social, and cyberbullying, to tailor appropriate intervention strategies.
• Assess the underlying causes of bullying behavior, including social and psychological factors, to develop prevention and intervention strategies.
• Collaborate with interprofessional team members to select appropriate therapeutic interventions and resources for victims and perpetrators of bullying.

Introduction

Bullying is a significant and pervasive yet preventable public health problem with detrimental consequences for children's physical and mental well-being. Bullying is a repeated and deliberate pattern of aggressive or hurtful behavior targeting individuals perceived as less powerful. [1] The CDC's formal and somewhat unwieldy definition is "any unwanted aggressive behavior 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."[CDC. Fast Facts: Preventing Bullying ] In Australia, the National Center Against Bullying defines bullying as an "ongoing and deliberate misuse of power in relationships through repeated verbal, physical or social behavior that intends to cause physical, social, or psychological harm." This activity focuses on children and youth younger than 18 and does not address adult or workplace bullying. 

Historically, bullying has been seen as a "rite of passage" in childhood, and even today, there often is a tacit acceptance of bullying behavior. Many healthcare professionals struggle to accept bullying as a public health issue. An increased awareness of the long-term consequences on physical and mental health necessitates a shift in these attitudes.[Campbell, Kristin. Bullying and Victimization . AAP] Populations at greater risk are those perceived as "different," including racial, religious, and ethnic minorities, immigrants, refugees, individuals with notable physical features or disabilities, and younger or more vulnerable children. Bullying episodes are usually unprovoked and deliberate, and bullies often seek visibility and prestige through their actions.

Healthcare professionals play a vital role in preventing and identifying bullying and assisting with mitigating its mental and physical health consequences. This overview provides clinicians with the knowledge and tools to increase their awareness of bullying, enabling early recognition and effective intervention. Bullying is a problem that affects victims, perpetrators, and bystanders, and this overview equips clinicians with the skills to improve the lives of affected youth.

Bullying can happen anywhere, although it is most common in and around schools. Bullying usually occurs in relatively unstructured situations and minimally supervised areas such as playgrounds, cafeterias, hallways, bus stops, and buses. Bullying manifests in various forms, such as physical, verbal, social/relational, and cyberbullying, each having unique characteristics. Verbal bullying, including name-calling and taunting, is the most frequent.

Cyberbullying has received much attention in the past few years, as children and teens now have easy access to digital devices and social media sites. Cyberbullying manifests as text messages, social media posts, emails, online forums, and other platforms, and the risk increases considerably with the duration of a child's online activity. The term was first coined in the 1990s but has only become a significant concern in the 21st century as rates have risen, especially during the COVID-19 pandemic when electronic media use soared during lockdowns. Name-calling occurs most frequently, but 15% of youth bullied online describe being scared. Teens also report receiving unsolicited and explicit images meant to intimidate them.[Vogels, Emily. Teens and Cyberbullying 2022 ]

Artificial intelligence (AI) has complicated this issue. The Wall Street Journal wrote about a group of high school boys who used an online tool powered by AI to create nude photographs of female classmates, which they spread electronically. Although this might have been an isolated event, these fake nude likenesses will persist in cyberspace indefinitely and are likely to cause irreparable adverse effects.[WSJ. Nov 4-5, 2023, p1] Despite these growing concerns, only 11% of teens talk with their parents or caregivers about their cyberbullying experiences.[Security.org. Cyberbullying ] Identifying this form of bullying is challenging because the episodes may be less repetitive than typical verbal or physical bullying. [2]  In many instances, perpetrators remain anonymous, allowing them to engage in behavior they might not display face-to-face with their victims. Because online content is easily preserved and disseminated, cyberbullying results in ongoing suffering, especially when hurtful messages "go viral." Cyberbullying differs from traditional bullying as it does not rely on physical proximity or a specific location and can occur at any time of day or night. Traditional bullying at school usually does not extend to the home setting, but victims of cyberbullying may feel they cannot escape since their electronic devices are turned on 24/7. Like traditional bullying, cyberbullying can cause profound adverse psychological effects.

Relational or social bullying occurs when the aggressor manipulates social relationships to harm or control the victim. Unlike physical and verbal bullying, which involve direct acts of aggression, relational bullying is more subtle. The aggressors often rely on tactics such as spreading rumors, excluding victims from social groups, and manipulating social dynamics to damage reputations or relationships. In social bullying, the bully aims to isolate, hurt, or control the victim emotionally, which can result in psychological and emotional sequelae. Social bullying is no longer restricted to the schoolyard but frequently takes the form of cyberbullying.

Clinicians play a crucial role in identifying bullying and treating the children it impacts. They screen patients for risk factors, educate families about coping skills, and advocate in their communities and local schools. School anti-bullying measures can help prevent bullying and empower youth to intervene when they are bystanders. This overview describes how clinicians can address bullying in an outpatient setting to improve child well-being and reduce its physical, psychological, social, and educational harms.

What creates a bully? Bullying results from a complex combination of individual, social, and environmental factors, and many youths who engage in it have specific backgrounds and qualities. Likewise, victims often share similar traits. 

Exposure to adverse childhood events increases the likelihood of becoming a bully. Associated characteristics include aggression, frustration, lack of empathy, poor impulse control, a tendency to blame others for their problems, an inability to accept responsibility for one's actions, a desire for power, the perception that others are hostile, and having friends who are bullies. Bullies have also been noted to exhibit more antisocial behaviors and use more marijuana and alcohol than their peers. [3]  Bullies do not always need to be physically stronger than their victims. The perceived power imbalance is derived from many factors, including popularity, socioeconomic status, peer group, and cognitive ability. Bullies frequently use their behavior to gain social status within their peer group. [4]  Some perpetrators may not consciously consider themselves bullies, especially those previously victimized. 

Bullying affects all socioeconomic groups, and lower socioeconomic status (SES) has been associated with higher rates of victimization. Still, higher SES does not necessarily prevent an individual from being targeted. [5] [6]  Children from dysfunctional families or those exposed to violence at home are more vulnerable. However, protective factors include being connected with a supportive family or caring adult, strong peer relationships, and having close friends. [7] [Bass, P and Scholar, S. How to Identify and Treat Bullying . Contemporary PEDS Journal] Empowering children with skills to cope with their feelings has been shown to shield them somewhat from bullying's negative effects. [8]  

Children perceived as "different" from their peers are more likely to experience bullying. [9]  This includes youth from racial and ethnic minorities, who may also be disproportionately impacted by other factors associated with bullying, such as adverse community and school environments. A strong ethnic identity and positive cultural and family values, however, may protect these children from the hurtful effects of bullying. [10]  Likewise, youth from religious minorities or immigrant and refugee groups are targeted more often than their peers. Other examples include children with noticeable physical features, such as birthmarks, tall or short stature, disabilities, and chronic medical conditions, including severe acne, seizures, neurofibromatosis, autism spectrum disorder, attention deficit disorder (ADHD), and obesity. [11]  Teens with obesity are twice as likely to be bullied as their normal-weight peers. [12]  Children who are socially isolated, unpopular, lacking in interpersonal skills, or those with few friends are vulnerable as well. 

Bullying frequently serves to enforce perceived social norms within adolescent peer groups, such as heterosexual relationships and traditional gender roles. Students who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ)  often find themselves the targets of bias-based bullying, with a reported incidence nearly twice that of other students. They experience higher rates of verbal bullying, physical bullying, and cyberbullying, leading to injuries, emotional distress, and even suicide.[Earnshaw et al. LBGTQ Bullying . AAP] 

Some individuals who engage in bullying behavior may have experienced bullying or victimization themselves. These "bully victims" are at even higher risk of psychosomatic and behavioral problems than their uninvolved peers and report increased rates of suicidal ideation and attempts.[Flannery et al. Bullying and School Violence. Pediatrics Clinics of North America ] 

Epidemiology

According to the National Center for Educational Statistics' School Crime Supplement (2019), 22% of students aged 12 to 18 report being bullied at school. Teachers and academic administrators consider it a frequent disciplinary problem, with 14% saying they deal with it daily or at least weekly. The types of bullying reported include being the subject of rumors (15%), verbal taunting (14%), exclusion from activities (6%), being pushed, shoved, tripped, or spit on (5%), physical threats (4%), and coercion for students to do things they did not want to or the destruction of their possessions. (2%)

The CDC (Preventing Bullying, 2023) reports that about 20% of US high school students report being bullied at school, with 17% overall and as many as 30% of girls reporting cyberbullying. Half say that cyberbullying is a "major problem."[Vogels, Emily.  Teens and Cyberbullying 2022 ]

About 40% of children report witnessing bullying at their school. [13]  This is a global issue, with cited rates internationally ranging from 5% to 45%. [14]  Most studies report a greater prevalence among boys than girls, especially among middle school children. For boys, physical and verbal bullying is typical, but girls experience more verbal and social bullying. [15]  Traditional bullying peaks around age 12 and then gradually declines. Recent research suggests that social and cyberbullying continue to increase during adolescence. [15] [16]  Racial, religious, and ethnic minority youth are disproportionately influenced by bullying, and Black teens experience bullying more than other groups. [17] [18]  They are twice as likely as Hispanic or White teens to report they feel their race made them a target of cyberbullying.[Vogels, Emily.  Teens and Cyberbullying 2022 ]

Approximately 40% of high school students who identify as lesbian, gay, bisexual, or unsure of their sexual identity report being bullied, while 22% of bisexual high school students report being targeted. LGBTQ students are bullied twice as often as their heterosexual and cisgender peers and are less likely to report it. [19] [20]

History and Physical

Bullying may be the chief complaint for an appointment in a clinical setting. However, many children do not disclose they are targets of bullying, and clinicians should be suspicious when the review of systems is positive for somatic complaints and nonspecific symptoms or warning signs appear in the social history. Bullied children can present with insomnia, nightmares, bedwetting, appetite changes, headaches, and stomachaches. When asked, they may endorse mood swings, feelings of helplessness, poor self-esteem, or suicidal thoughts. Children who are bullied may exhibit psychosomatic symptoms or have previously been diagnosed with anxiety or depression. [21] [22]  Social history clues include school absenteeism, declining grades, loss of friends, and lost or damaged belongings such as school books and clothing. 

Recognizing at-risk children early may avert long-term consequences. Identifying risk factors can help prevent bullying, and early detection is the first step in intervention. Clinicians who screen for bullying can support affected families and direct them to appropriate resources. They can utilize validated screening tools such as the HEADDS (Home, Education/employment, Activities, Drugs, Sexuality, Suicide/depression) assessment [23]  or the Bright Futures questionnaires from the American Academy of Pediatrics.[Hagen et al. Bright Futures. AAP] The Bullying, Cyberbullying, and Social Media Use Pediatric Checklist is available online from the Massachusetts Aggression Reduction Center (www.MARCcenter.org) and is free for clinicians. Identifying victims can be tricky since many children do not readily disclose their involvement in bullying. Clinicians should, therefore, foster an inclusive and affirming healthcare environment where youth feel safe discussing their identities and experiences. [24]  This is especially important for LGBTQ patients who may not view their homes or schools as supportive.

About 70% of victims do not want to admit it to an adult, and indirect questioning during the medical history-taking may yield additional information. Inquiring about how school is going or if kids have friends to sit with at lunch may provide insight into how bullying might be a problem. [25]

Physical examination is usually unremarkable, but weight gain or loss alerts clinicians to possible appetite issues, and unexplained bruises or cuts may indicate physical altercations or self-inflicted injuries, necessitating further evaluation. 

Primary care clinicians are often asked to evaluate children for learning or behavior problems, including possible ADHD. An example is a teen boy who previously was a strong student, active in sports, and a musician in the school band who presents with declining grades. The teacher questions attention issues since he no longer completes his homework and says he "forgets to do it."  Further questioning reveals that a classmate has been confronting him daily after school, grabbing his backpack and dumping its contents. Therefore, he leaves his bag in his locker to avoid these unpleasant encounters and no longer finishes or turns in his assignments. He will not require an educational or psychiatric evaluation for ADHD once the clinician identifies that bullying is the underlying cause of his declining grades. 

Another example is a teen immigrant girl with weight loss whose mother is concerned she does not like American school lunches. However, a thorough history and physical examination reveal she has been feeling isolated, and she reports that kids tease her incessantly about her lack of English language skills. No one will sit with her at lunchtime, so she avoids the cafeteria. She admits to mood swings, and the physical examination is notable for self-inflicted cutting scars on her forearms. The clinician must elicit further information to determine if she is at risk of suicidal ideation or behavior before developing a management plan and arranging follow-up.

Bullying belongs to the spectrum of recurrent traumatic experiences of childhood, with similar physiologic, psychologic, social, and cognitive outcomes as child maltreatment or family violence.[Campbell, Kristin.  Bullying and Victimization . AAP] According to the American Academy of Pediatrics (AAP), trauma-informed care is medical care that recognizes the results of traumatic stress on children and their families. Clinicians are often the first professionals who interact with those affected by trauma and have the opportunity and obligation to respond sensitively. They can ensure a patient's safety and confidentiality, use respectful language, and support autonomy. [26]  A trauma-informed physical examination serves to establish trust and reduce feelings of vulnerability or potential triggers of prior traumatic events. [27] [28]  In the case of the teen with cutting scars, this may be the first occasion anyone has seen her skin lesions that are usually covered by her clothing. Performing the examination calmly and privately will foster confidence and encourage the girl to relate further relevant details about her unfortunate experiences.

When bullying is suspected or confirmed, the clinician should first speak with the child directly and privately to assess the severity of the problem. Because this may be the first time sharing such sensitive information, the clinician should create a safe space for the child to feel comfortable, using open-ended questions, active listening, and empathy, and ensuring confidentiality unless a situation mandates reporting to authorities. 

A simple approach is to ask these three questions:

• Are you being bullied?
• How often does this happen?
• How long has this been going on? [29]

Understanding the nature and extent of the episodes is essential for effective intervention. The clinician must differentiate between physical, verbal, social, and cyberbullying, as each requires a unique approach. Assessing the severity of the incidents helps prioritize support and resources and determine if a child's welfare is threatened and if reporting to child protective services is mandated. Clinicians should also inquire about other forms of victimization, such as child maltreatment and domestic violence, during the confidential interview. 

Further evaluation usually co-occurs with treatment and management, as presented in the next section. 

Treatment / Management

How can clinicians manage bullying? When bullying is suspected or confirmed, they should gather additional information about the circumstances and context from the patient, caregivers, and teachers if indicated. Next, they must decide whether to provide anticipatory guidance, direct families to helpful resources, refer them to a mental health specialist, or contact the school or appropriate law enforcement authorities. [8]  In all cases, clinicians should first ensure the child's safety. Most cases of bullying are not emergencies, but at times, a child is in imminent danger, has been the victim of physical or sexual abuse, or has expressed thoughts of suicidal ideation. Clinicians must know when to elevate the level of care and facilitate transporting such children to the nearest emergency facility for evaluation. [8]

When clinicians treat victims of bullying in an outpatient setting, they must first ensure that children feel safe and realize that they are not at fault. Clinicians can teach them skills to use when confronted by bullies. Children should tell the bully to stop, then walk away and notify a trusted adult. They must inform another adult if they have already reported the circumstances and nothing was done. Clinicians can participate in brief role-playing activities with their patients and encourage parents and caregivers to rehearse successful, assertive behaviors at home with their children. Many parents do not know where to start when their child is a target of bullying and appreciate information from trusted clinicians about the signs and effects of bullying and how to convey their concerns to teachers and counselors. Caregivers can be directed to valuable resources such as stopbullying.org  and marccenter.org  and encouraged to promote youth activities that build self-esteem, such as sports and hobbies. Clinicians can advise parents and caregivers not to call the bully's parents or try to retaliate but allow the school to investigate. Parents may also benefit from training to discuss bullying and other issues with their children. [25] They must monitor children's online activity, discuss the possible consequences of their media use, and ask if they have experienced any problems online. Clinicians can recommend never forwarding or responding to hurtful messages and advise keeping evidence of inappropriate digital media, blocking cyberbullies, and always informing a trusted adult about inappropriate content. Clinicians can arrange counseling and mental health services when indicated and work with schools and other agencies as applicable to protect victims from further harm. 

Most structured bullying interventions occur in academic settings, and clinicians should know about local programs when caregivers and schools seek their expertise in addressing bullying. All states in the US require schools to develop anti-bullying policies and procedures, and similar initiatives exist in many other countries. [14]  Clinicians should understand their community's statutes and develop step-by-step strategies to investigate reports when necessary. [30]  School-based initiatives vary, but successful programs promote empathy for victims, strengthen coping and socialization skills, educate staff and families, and foster a schoolwide anti-bullying culture. [31]  Schools can empower bystanders to intervene when they witness bullying. In one study, 57% of episodes ceased within ten seconds when an onlooker spoke up, but they only did so 15-20% of the time. [32] .[Salmivalli, C. Bullying and the Peer Group . Aggression and Violent Behavior.] On the other hand, bystanders who actively support or encourage bullies can empower them to continue their aggressive behavior. Multidisciplinary interventions targeting peer groups rather than individuals involving families, schools, and communities may have the most impact. [33] [34]  Unfortunately, such multifaceted programs are costly, and the effects are difficult to measure. [35]  A meta-analysis of such school initiatives reported a mean decrease of approximately 20% in bullying rates, demonstrating room for improvement. [36]  

Outside their practices, clinicians can advocate locally, in their states, and nationally to support anti-bullying initiatives. They can work to improve community education and services and lobby to strengthen anti-bullying laws and evidence-based policies that prohibit bullying based on racial, ethnic, or sexual stereotypes.

Clinicians are also likely to care for the perpetrators of bullying. It is essential to denounce the behavior but not the child. Bullies themselves may well have been victims and need to tell their stories. Clinicians should listen without interrupting, remain nonconfrontational, and express concern for the victim. They can set boundaries for acceptable behavior, ask the patient to describe their actions, and suggest ways to improve. Effective clinicians communicate that bullying is always inappropriate and will not be tolerated, but also seek to appreciate the underlying causes or circumstances. They can recommend consistent disciplinary consequences, such as removing privileges or making reparations. They can connect with the child's school and advocate for penalties such as mandated community service rather than suspension or expulsion, which should be reserved for youth exhibiting severely disruptive or aggressive behavior. Overly harsh policies often ignore the underlying social and behavioral issues contributing to bullying and may lead students to abandon formal education early. Bullies should be assessed for psychosocial problems and offered mental health counseling if indicated. Some children may even cease bullying when they become aware of the hurt they have caused others and learn alternative coping methods for their feelings. 

Differential Diagnosis

Clinicians can usually elicit a history of bullying if they take the time to ask relevant questions and listen carefully to the patient's responses. However, symptoms frequently associated with bullying may be nonspecific and result from other concerning circumstances, such as peer conflict, dating violence, family dysfunction, harassment, or hazing. [37]  These issues must be addressed and treated accordingly. When bullying is identified as the problem, clinicians should evaluate victims for mental health consequences, including posttraumatic stress disorder, anxiety, depression, and suicidal ideation, understanding that the presence of multiple coexisting issues may worsen the patient's physical and emotional health.  

In the medical model, prognosis predicts disease outcomes, such as recovery, recurrence, and death. Bullying, however, is not a disease, and the focus centers on consequences and complications rather than prognosis. In general use, however, the word prognosis forecasts a likely outcome. The medical and educational literature indicates that unless effective prevention and intervention measures are adopted, the prognosis for bullying is grim, and it will continue to take its toll on children and youth around the globe. 

Complications

Bullying is associated with short and long-term adverse physical and mental health outcomes. [38] [39]  Even when adequately treated, some physical injuries may cause lingering disabilities. Victims often experience academic difficulties, such as worsening grades, absenteeism, and concentration problems. In recent years, unfavorable consequences have been increasingly recognized for both victims and bullies, including social isolation, anxiety, depression, suicidality, and illicit substance use. [40] [41]  These sequelae often continue into adulthood. Stigma-based bullying has been even more strongly associated with health problems than bullying in general. [24]

Victims of severe bullying may feel threatened and depressed and are at risk of developing post-traumatic stress disorder. As adults, they are more likely to carry weapons and have higher rates of suicide attempts and poor psychosocial adjustment. [42] [43]  In one study, victims of bullying in grade 5 used more tobacco, marijuana, and alcohol in grade 10. [44] The self-medication hypothesis suggests these substances are consumed to cope with painful emotions related to psychological trauma. [44]  Depression, anxiety, relationship problems, poor health, failing academic performance, suicidal ideation and attempts, and sleep problems have all been associated with being bullied. [45] [46]  Another study demonstrated homophobic name-calling by nonfriends was linked with increased psychological distress among LGBTQ students, and LGBTQ youth who commit suicide are nearly five times as likely to have been bullied compared with their non-LGBTQ peers who take their own lives. [47] [May 26, 2020. 10.1001/jamapediatrics.2020.0940]   LGBTQ bullying is also associated with increased rates of adolescent substance use, including tobacco, alcohol, marijuana, and illicit drugs [48]  

Teens who have been physically threatened or in a fight are more likely to bring a weapon to school than other bullying victims or nonvictims. They are also more inclined to display violent behaviors at school, contributing to an unsafe academic environment.[Pham et al. Weapon Carrying Among Victims of Bullying . AAP]

Youth who bully often exhibit a negative attitude towards school and may leave before graduating, especially if they are punished by expulsion. Long-term associated consequences include criminal activities and arrests, intimate partner violence, delinquency, and antisocial behavior. [49] ]

Youth who are "bully victims" may experience even worse outcomes than their peers. They have been reported to have higher rates of child mental health issues, more thoughts of self-harm and suicidality, and increased substance use. [50] [51] [52]  Supportive adults at home and school may serve to buffer youth from the effects of bullying on future substance use. Still, controlled studies are lacking because it is difficult to separate bullying from other issues contributing to substance use, such as anxiety or other significant traumatic childhood events. 

Consultations

Several school and community bullying prevention centers provide resources and specialized support to counter bullying. In addition, helplines for bullying and cyberbullying are available in many countries.

The following resources are confidential, free, and available 24/7:

Stop Bullying Now Hotline

• 1-800-273-8255 or www.stopbullying.gov 
• Established by the US Department of Health and Human Services
• Available to adults and children

The Massachusetts Aggression Reduction Center 

www.MARCcenter.org Bullying And Cyberbullying Prevention and Advocacy Collaborative (BACPAC) at Children's Hospital Boston: www.childrenshospital.org/BACPAC

Childline 

• 0800 1111 (United Kingdom)
• Available to children under 18 years
• Offers advice and counseling to young people in distress or abusive situations

Kids Helpline

• 1-800-55-1800 (Australia)
• Provides advice to children, parents, and schools

Deterrence and Patient Education

Bullying prevention programs, usually found in school systems, may deter bullying and its effects. Few randomized controlled trials evaluate their efficacy, and it is unlikely that one approach will work in every school or community.[Flnnery et al. Bullying and School Violence.  Pediatrics Clinics of North America ] Successful strategies include an academic culture that does not tolerate bullying, involves bystanders, encourages classroom discussions with role-playing, improves supervision in less-structured areas like playgrounds, and offers educational programs for parents and caregivers. Isolated curriculum interventions are less effective than multidisciplinary programs that allow teachers and all school ancillary staff to participate, including cafeteria workers, administrators, custodians, and bus drivers. [53]  Some schools use focus groups to guide program content and strategize to understand children's perspectives. [54]

Schools with gay-straight alliance clubs demonstrate increased well-being among LGBTQ students. An example of a statewide effort is the Massachusetts Safe Schools Program for LGBTQ Students, a joint initiative between the  Department of Elementary and Secondary Education and the Massachusetts Commission on LGBTQ Youth. It includes classroom instruction, student activities, teacher proficiency workshops, and opportunities for policy development. [24] [55]  Clinicians can recommend that communities and schools use ideas from this and similar programs as models when developing their guidelines.

Pearls and Other Issues

Bullying is not primarily a law enforcement issue, but all 50 states in the US have enacted school anti-bullying legislation or policies. Bullying may also appear in the criminal code related to other crimes, such as aggravated harassment or stalking, and may apply to juveniles, depending upon the locale. Clinicians should be informed about the laws in their communities, report incidents when legally required to do so, and continue to advocate for their young patients.

Enhancing Healthcare Team Outcomes

How can the interprofessional team come together to prevent and intervene with bullying? Pediatricians and other primary care clinicians who care for children are the team leaders for identifying and treating youth affected by bullying. They are experts in advocating for their patients and working with medical specialists, nurses, mental health professionals, teachers, school administrators, parents, and other caregivers. 

The first step is to routinely screen youth for bullying exposure and identify subtle indicators when patients do not readily disclose they are victims. The American Academy of Pediatrics recommends violence prevention counseling for school-age children and screening at well-child visits beginning at age 6. [56]  Clinicians and nurses identify and assess victims and perpetrators of bullying and counsel youth and their caregivers about practical actions. Next, clinicians decide when a referral to a mental health provider or social worker is indicated and arrange appropriate and timely follow-up after the initial consultation. [57]  

Clinicians and mental health specialists teach parents and caregivers communication skills and positive discipline strategies since it is known that children from supportive families are more resistant to bullying and less likely to become perpetrators. Family therapists work on reducing anger and improving interpersonal relationships in dysfunctional families since bullying is often only one symptom of maladjustment in the home.

Clinicians advocate for children at school and assist parents and caregivers in connecting with teachers and administrators. They advise schools on the mental and physical health consequences of bullying and serve as a resource when schools establish and promote policies and academic environments that condemn bullying. These programs teach children who are bystanders to intervene and potentially dissuade bullies, who may feel pressure to conform to the behavior of the majority. [58] [59] [57]  Schools that foster a culture of empathy and encourage students to report bullying may be more successful in reducing its prevalence and consequences. Teachers, administrators, and school nurses often are firsthand witnesses who communicate their concerns to primary care clinicians who assess children for physical and mental health sequelae. The interprofessional team supporting children's welfare includes child protection agencies and law enforcement officials. Clinicians engage with them to coordinate care when necessary to safeguard at-risk children.

In summary, identifying and addressing bullying takes an interprofessional team led by primary care clinicians, including medical, mental health, educational, law enforcement, and community specialists, who work together to achieve optimal health outcomes for youth experiencing this all-too-frequent public health problem.

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Disclosure: Muhammad Waseem declares no relevant financial relationships with ineligible companies.

Disclosure: Amanda Nickerson declares no relevant financial relationships with ineligible companies.

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Bullying is unwanted aggressive behavior by another person or group of people. In bullying, there is always an actual or perceived power imbalance, and the aggression is repeated multiple times or is highly likely to be repeated. Bullying also includes cyberbullying, a type of aggression that is carried out through electronic means, such as through the Internet, e-mail, or mobile devices. People of all ages can be bullied, and bullying may take place at home, school, or work. Because of cyberbullying, bullying can occur almost anywhere at any time.

About Bullying

Bullying is when a person or a group shows unwanted aggression toward another person. 1 To be considered bullying, the behavior in question must be aggressive. 2  The behavior must also involve an imbalance of power (e.g., physical strength, popularity, access to embarrassing details about a person) and be repetitive, meaning that it happens more than once or is highly likely to be repeated. 2

Bullying can be 2 :

• Physical: punching, beating, kicking, or pushing; stealing, hiding, or damaging another person's belongings; forcing someone to do things against his or her will
• Verbal: teasing, calling names, or insulting another person; threatening another person with physical harm; spreading rumors or untrue statements about another person
• Relational: refusing to talk to someone or making them feel left out; encouraging other individuals to bully someone

Bullying also includes cyberbullying and workplace bullying.

• Cyberbullying has increased with the increased use of the social media sites, the Internet, e-mail, and mobile devices. 3  Unlike more traditional bullying, cyberbullying can be more anonymous and can occur nearly constantly. 3  A person can be cyberbullied day or night, such as when they are checking their e mail, using Facebook or another social network site, or even when they are using a mobile phone. 3
• Workplace bullying refers to adult behavior that is repeatedly aggressive and involves the use of power over another person at the workplace. 4  Certain laws apply to adults in the workplace to help prevent such violence.  Read more from CDC about occupational violence and laws to prevent it .
• Centers for Disease Control and Prevention. (2014).  Featured topic: bullying research. Retrieved on January 28, 2014, from http://www.cdc.gov/violenceprevention/youthviolence/bullyingresearch/
• U.S. Department of Health and Human Services. (.). What is bullying?  Bullying definition.  Retrieved on August 7, 2012, from  http://www.stopbullying.gov/what-is-bullying/
• Eunice Kennedy Shriver  National Institute of Child Health and Human Development. (2010).  Taking a stand against bullying.  Retrieved on August 7, 2012, from http://www.nichd.nih.gov/news/resources/spotlight/092110-taking-stand-against-bullying
• U.S. Department of Health and Human Services. (n.d.).  Workplace bullying.  Retrieved on August 7, 2012, from  http://www.stopbullying.gov/what-is-bullying/related-topics/index.html#workplace

Who is affected and how many are at risk for bullying?

People of all ages can be bullied. Bullying may take place at home, school, or work.

• A 2013 survey from the National Center for Education Statistics found that bullying continues to affect many school-aged children 1 : Slightly more than 1 out of 5 students in middle and high school experienced “traditional” bullying at school during the 2012–2013 school year. Six percent of students ages 12 to 18 reported that they had been pushed, shoved, tripped, or spit on during the school year. Of these students, 22% reported being injured in the event.
• The 2013 survey found that, during the same school year, 7% of students reported being cyberbullied. 3
• Data from the 2015 Youth Risk Behavior Surveillance System from the Centers for Disease Control and Prevention indicate that about 20% of U.S. students in grades 9 through 12 experienced bullying on school property within the last year. 2
• National Center for Education Statistics. (2016). Indicators of school crime and safety: 2015. Retrieved September 1, 2016, from https://nces.ed.gov/pubs2016/2016079.pdf (PDF 2.8 MB)
• Centers for Disease Control and Prevention. (2016). Youth risk behavior surveillance system. Morbidity and Mortality Weekly Report, 65 , 6. Retrieved June 17, 2016, from http://www.cdc.gov/healthyyouth/data/yrbs/pdf/2015/ss6506_updated.pdf (PDF 2.91 MB)
• National Center for Education Statistics. (2015). Indicators of School Crime and Safety: 2014 . Retrieved June 17, 2016, from https://nces.ed.gov/pubs2015/2015072.pdf (PDF 4.14 MB)

What are common signs of being bullied?

Signs of bullying include 1 , 2 , 3 :

• Depression, loneliness, or anxiety
• Low self-esteem
• Headaches, stomachaches, tiredness, or poor eating habits
• Missing school, disliking school, or having poorer school performance than previously
• Self-destructive behaviors, such as running away from home or inflicting harm on oneself
• Thinking about suicide or attempting to commit suicide
• Unexplained injuries
• Lost or destroyed clothing, books, electronics, or jewelry
• Difficulty sleeping or frequent nightmares
• Sudden loss of friends or avoidance of social situations
• Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2010). Taking a stand against bullying. Retrieved June 17, 2016, from http://www.nichd.nih.gov/news/resources/spotlight/092110-taking-stand-against-bullying
• U.S. Department of Health and Human Services. (n.d.). Who is at risk? Warning signs. Retrieved June 17, 2016, from http://www.stopbullying.gov/at-risk/warning-signs/index.html

How does bullying affect health and well-being?

Bullying can affect physical and emotional health, both in the short term and later in life. It can lead to physical injury, social problems, emotional problems, and even death. 1 Those who are bullied are at increased risk for mental health problems, headaches, and problems adjusting to school. 2 Bullying also can cause long-term damage to self-esteem. 3

Children and adolescents who are bullies are at increased risk for substance use, academic problems, and violence to others later in life. 2

Those who are both bullies and victims of bullying suffer the most serious effects of bullying and are at greater risk for mental and behavioral problems than those who are only bullied or who are only bullies. 2

NICHD research studies show that anyone involved with bullying—those who bully others, those who are bullied, and those who bully and are bullied—are at increased risk for depression. 4

NICHD-funded research studies also found that unlike traditional forms of bullying, youth who are bullied electronically—such as by computer or cell phone—are at higher risk for depression than the youth who bully them. 5 Even more surprising, the same studies found that cyber victims were at higher risk for depression than were cyberbullies or bully-victims (i.e., those who both bully others and are bullied themselves), which was not found in any other form of bullying. Read more about these findings in the NICHD news release: Depression High Among Youth Victims of School Cyberbullying, NIH Researchers Report .  

• Centers for Disease Control and Prevention. (2015). Fact sheet: Understanding bullying . Retrieved June 17, 2016, from https://www.cdc.gov/violenceprevention/pdf/bullying-factsheet508.pdf (PDF - 356 KB).
• Smokowski, P. R., & Kopasz, K. H. (2005). Bullying in school: An overview of types, effects, family characteristics, and intervention strategies. Children and Schools, 27, 101–109.
• Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2012). Focus on children's mental health research at the NICHD. Retrieved June 17, 2016, from http://www.nichd.nih.gov/news/resources/spotlight/060112-childrens-mental-health

What are risk factors for being bullied?

Those who are at risk of being bullied may have one or more risk factors 1 , 2 , 3 :

• Are seen as different from their peers (e.g., overweight, underweight, wear their hair differently, wear different clothing or wear glasses, or come from a different race/ethnicity)
• Are seen as weak or not able to defend themselves
• Are depressed, anxious, or have low self-esteem
• Have few friends or are less popular
• Do not socialize well with others
• Suffer from an intellectual or developmental disability
• U.S. Department of Health and Human Services. (n.d.). Who is at risk? Risk factors. Retrieved June 17, 2016, from http://www.stopbullying.gov/at-risk/factors/index.html
• U.S. Department of Health and Human Services. (n.d.). Who is at risk? Considerations for specific groups. Retrieved June 17, 2016, from http://www.stopbullying.gov/at-risk/groups/index.html

What can be done to help someone who is being bullied?

To help someone who is being bullied, support the person and address the bullying behavior. Other ways to help—including what to do if a person is in immediate danger—are listed below.

Support a child who is being bullied: 1

• You can listen to the child and let him or her know you are available to talk or even help. A child who is being bullied may struggle talking about it. Consider letting the child know there are other people who can talk with him or her about bullying. In addition, you might consider referring the child to a school counselor, psychologist, or other mental health specialist.
• Give the child advice about what he or she can do. You might want to include role-playing and acting out a bullying incident as you guide the child so that the child knows what to do in a real situation.
• Follow up with the child to show that you are committed to helping put a stop to the bullying.

Address the bullying behavior: 1

• Make sure a child whom you suspect or know is bullying knows what the problem behavior is and why it is not acceptable.
• Show kids that bullying is taken seriously. If you know someone is being a bully to someone else, tell the bully that bullying will not be tolerated. It is important, however, to demonstrate good behavior when speaking with a bully so that you serve as a role model of good interpersonal behavior.

The " Bullying: Be More Than a Bystander " resource, which includes a presentation and facilitator's guide , seeks to educate people about taking action against bullying. It suggests you can help someone who is being bullied in the following ways: 2

• Be a friend to the person who is being bullied, so they do not feel alone.
• Tell a trusted adult if you see someone being bullied.
• Help the person get away from the bullying without putting yourself at risk.
• Don't enable bullying by providing an audience.
• Set a good example by not bullying.

If you feel that you have taken all possible steps to prevent bullying and nothing has worked, or someone is in immediate danger, there are other ways for you to help. 3

Table modified from http://www.stopbullying.gov/get-help-now/index.html 3

• U.S. Department of Health and Human Services. (n.d.). Respond to bullying: Support the kids involved (Support kids who are bullied). Retrieved June 17, 2016, from http://www.stopbullying.gov/respond/support-kids-involved/index.html#support
• NICHD. (2015). Bullying: be more than a bystander (presentation). Washington, DC: U.S. Government Printing Office.
• U.S. Department of Health and Human Services. (n.d.). Get help now . Retrieved June 17, 2016, from http://www.stopbullying.gov/get-help-now/index.html

NICHD Bullying Research Goals

NICHD aims to understand the short- and long-term health effects of bullying, how the patterns of bullying have changed over time, and other information. NICHD’s research on bullying includes traditional bullying behavior (physical, verbal, and relational) as well as electronic aggression (“cyberbullying”).

Some of NICHD’s projects related to bullying include but are not limited to:

• Examining the co-occurrence of different types of bullying, including physical, verbal, social exclusion, spreading rumors, and cyberbullying, as well as their physical and psychological effects
• Determining the health and behavioral consequences of bullying, as well as the outcomes to those being bullied
• Identifying characteristics and other factors that increase a child’s risk for being bullied
• Determining the prevalence of bullying and being bullied among children from different countries and comparing rates across countries
• Identifying changes in bullying patterns and frequency over time and how these differ between and among different countries

Bullying Research Activities and Advances

NICHD supports and conducts a range of research on bullying. In addition to its own research, the Institute collaborates with other NIH Institutes and organizations to further our understanding of bullying.

Institute Activities and Advances

The following is only a summary of some of the Institute's efforts related to bullying.

Child Development & Behavior Branch (CDDB) research supports a number of projects related to bullying through its Social and Emotional Development/Child and Family Processes Program . Some of these include:

• Identifying Positive Aspects of Youth Internet Use: The Next Step in Prevention ( Michele Ybarra, Internet Solutions for Kids, Inc.)
• Social Aggression: Growth and Outcomes (Marion Underwood, University of Texas at Dallas)
• Bullying Prevention Intervention for Adolescent Primary Care Patients (Megan Ranney, Rhode Island Hospital)
• Reducing Problem Behaviors Through PYD: An RCT of Restorative School Practices (Joie Danielle Acosta, RAND Corporation)
• Development of the CABS: Child-Adolescent Bullying Screen (Judith Vessey, Boston College)

The CDBB is soliciting Small Business Innovation Research (SBIR) grants to develop and test games that address bullying and cyberbullying, such as games that raise awareness about bullying or help those being bullied cope.

Division of Intramural Population Health Research (DIPHR) research on bullying is aimed at understanding the prevalence and patterns in bullying and how they change over time. Some of the DIPHR projects related to bullying include:

• Examining cross-national health trends in children, including the prevalence of bullying
• Identifying bullying and victimization factors in school-aged children
• Characterizing the link between cyberbullying and depression in both bullies and those who are victimized by bullies

Other NICHD-supported studies include:

• Co-occurrence of victimization for several subtypes of bullying, including physical, verbal, social exclusion, rumor spreading, and cyberbullying
• Predictors of being bullied, such as weight status and race/ethnicity
• Likelihood of substance use among adolescents who have been bullied

Other Activities and Advances

• NICHD adapted materials from the stopbullying.gov website to create the "Bullying: Be More Than a Bystander" educational resource . The resource includes a presentation and facilitator's guide to educate students on how they can support someone who is being bullied.
• Research co-funded by NICHD and the National Institute of Mental Health to study the mental health effects of verbal victimization, the risk of self-harm after being bullied, and the genes that are associated with the development of emotional problems after being bullied
• Research co-funded by NICHD and the National Institute of Drug Abuse to study the effects of bullying on adolescent substance abuse
• Research co-funded by NICHD and the National Institute of Diabetes and Digestive and Kidney Diseases on sexual orientation and being bullied
• NICHD staff participated in planning the Federal Partners in Bullying Prevention Summit . Dr. Layla Esposito, director of the program on Process in Social and Emotional Development, serves on the Federal Partners in Bullying Prevention Steering Committee, an interagency effort that was launched in early 2010 to focus on the problem of bullying. Members of the committee help plan the Federal Partners in Bullying Prevention Summits.
• NICHD also participated in the Surgeon General's Workshop on Making Prevention of Child Maltreatment a National Priority: Implementing Innovations of a Public Health Approach . This workshop was convened to discover and elucidate effective strategies for preventing child maltreatment, including bullying, and promoting child well treatment.

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Facts About Bullying

This section pulls together fundamental information about bullying, including:

Research on Bullying

Bullying statistics, bullying and suicide, anti-bullying laws, definition of bullying.

In 2014, the Centers for Disease Control and Department of Education released the first federal  definition of bullying . The definition includes three core elements:

• unwanted aggressive behavior
• observed or perceived power imbalance
• repetition or high likelihood of repetition of bullying behaviors

This definition helps determine whether an incident is bullying or another type of aggressive behavior or both.

Bullying prevention is a growing research field that investigates the complexities and consequences of bullying. Important areas for more research include:

• Prevalence of bullying in schools
• Prevalence of cyberbullying in online spaces
• How bullying affects people
• Risk factors for people who are bullied, people who bully others, or both
• How to prevent bullying
• How media and media coverage affects bullying

What We’ve Learned about Bullying

• Bullying affects all youth, including those who are bullied, those who bully others, and those who witness bullying. The effects of bullying may continue into adulthood.
• There is not a single profile of a young person involved in bullying. Youth who bully can be either well connected socially or marginalized, and may be bullied by others as well. Similarly, those who are bullied sometimes bully others.
• Solutions to bullying are not simple.  Bullying prevention  approaches that show the most promise confront the problem from many angles. They involve the entire school community—students, families, administrators, teachers, and staff such as bus drivers, nurses, cafeteria and front office staff—in creating a culture of respect. Zero tolerance and expulsion are not effective approaches.
• Bystanders, or those who see bullying, can make a huge difference when they intervene on behalf of someone being bullied.
• Studies also have shown that adults can help prevent bullying by talking to children about bullying, encouraging them to do what they love, modeling kindness and respect, and seeking help.

Here are federal statistics about bullying in the United States. Data sources include the Indicators of School Crime and Safety: 2019 (National Center for Education Statistics and Bureau of Justice) and the 2017 Youth Risk Behavior Surveillance System  (Centers for Disease Control and Prevention).

How Common Is Bullying

• About 20% of students ages 12-18 experienced bullying nationwide.
• Had the ability to influence other students’ perception of them (56%).
• Had more social influence (50%).
• Were physically stronger or larger (40%).
• Had more money (31%).

Bullying in Schools

• Nationwide, 19% of students in grades 9–12 report being bullied on school property in the 12 months prior to the survey.
• Hallway or stairwell (43.4%)
• Classroom (42.1%)
• Cafeteria (26.8%)
• Outside on school grounds (21.9%)
• Online or text (15.3%)
• Bathroom or locker room (12.1%)
• Somewhere else in the school building (2.1%)
• Approximately 46% of students ages 12-18 who were bullied during the school year notified an adult at school about the bullying.

Cyberbullying

• Among students ages 12-18 who reported being bullied at school during the school year, 15 % were bullied online or by text.
• An estimated 14.9% of high school students were electronically bullied in the 12 months prior to the survey.

Types of Bullying

• Students ages 12-18  experienced  various types of bullying, including:
• Being the subject of rumors or lies (13.4%)
• Being made fun of, called names, or insulted (13.0%)
• Pushed, shoved, tripped, or spit on (5.3%)
• Leaving out/exclusion (5.2%)
• Threatened with harm (3.9%)
• Others tried to make them do things they did not want to do (1.9%)
• Property was destroyed on purpose (1.4%)

State and Local Statistics

Follow these links for state and local figures on the following topics:

• Bullied on School Property, Grades 9-12
• Cyberbullied, Grades 9-12

International Statistics

According to the UNESCO Institute of Statistics :

• One third of the globe’s youth is bullied; this ranges from as low as 7% in Tajikistan to 74% in Samoa.
• Low socioeconomic status is a main factor in youth bullying within wealthy countries.
• Immigrant-born youth in wealthy countries are more likely to be bullied than locally-born youth.

The relationship between bullying and suicide is complex. The media should avoid oversimplifying these issues and insinuating or directly stating that bullying can cause suicide. The facts tell a different story. It is not accurate and potentially dangerous to present bullying as the “cause” or “reason” for a suicide, or to suggest that suicide is a natural response to bullying.

• Research indicates that persistent bullying can lead to or worsen feelings of isolation, rejection, exclusion, and despair, as well as depression and anxiety, which can contribute to suicidal behavior.
• The vast majority of young people who are bullied do not become suicidal.
• Most young people who die by suicide have multiple risk factors.
• For more information on the relationship between bullying and suicide, read “ The Relationship Between Bullying and Suicide: What We Know and What it Means for Schools ” from the CDC.

All states have  anti-bullying legislation . When bullying is also harassment and happens in the school context, schools have a legal obligation to respond to it according to  federal laws .

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Bullying: Everything You Need to Know

• Why It Happens

Frequently Asked Questions

Bullying is any unwanted or aggressive behavior from someone who is intentionally trying to upset, harm, or have power over you. Bullying occurs among children, adolescents, and teens, either in person, online, or through social media. Adults can also be bullied, both in social groups and in the workplace.

Read on to learn more about the main types of bullying, signs someone is being bullied, and how to deal with a bully.

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6 Types of Bullying

In the United States in 2019, 1 out of 5 children ages 12–18 reported being bullied at school. Bullying included being:

• Made fun of or called names
• Pressured into doing things
• Excluded from activities
• Pushed, shoved, tripped, or spit on
• The subject of rumors

There are six main types of bullying, as discussed below.

Verbal Bullying

Verbal bullying is when someone is saying or writing harmful things or making threats. It includes:

• Name-calling
• Threatening to cause harm
• Making inappropriate comments

Social Bullying

Social bullying is also called relational bullying, relational aggression, or emotional bullying. It involves threatening someone's reputation or relationships.

Social bullying can include:

• Excluding someone on purpose
• Spreading rumors and gossip about someone
• Shunning, or telling others not to interact or be friends with someone
• Publicly embarrassing someone

Physical Bullying

Physical bullying includes bodily harm or damage to possessions. Any form of aggressive physical contact constitutes physical bullying.

This type of bullying can include:

• Hitting, kicking, or spitting on someone
• Tripping or pushing someone
• Taking or breaking someone’s things
• Making mean or inappropriate gestures

Cyberbullying

Cyberbullying involves bullying or harassing someone online or through social media. This harassment can occur on a computer, telephone, cell, or text messaging device.

Cyberbullying can include:

• Sending mean texts
• Posting insults about someone on social media
• Making rude comments about someone's posts
• Posting or sending personal information about someone to others in order to hurt or embarrass that person
• Threatening someone or bullying them through online chats or groups

In a 2018 survey, 59% of U.S. teens reported being cyberbullied.

Racist Bullying

Racist or racial bullying can include all other types of bullying, even physical attacks. It includes:

• Belittling, mocking, or intimidating someone because of their race
• Devaluing someone's racial background
• Discrediting someone's religious or cultural practices
• Insulting or shaming a person's speech, the way they dress, or their customs

Sexual Bullying

Sexual bullying includes any unwanted sexual physical contact, inappropriate comments, or online harassment. It includes:

• Sending or posting sexually explicit photos, messages, or videos
• Making inappropriate sexual comments, jokes, or hand gestures
• Spreading sexual rumors
• Groping, grabbing, or touching in a sexual manner
• Pressuring someone for sex or sexually explicit photos

Help Is Available for Bullying

If you or someone you know is having thoughts of suicide or self-harm because of bullying, you can contact the  National Suicide Prevention Lifeline  at  988  for support and assistance from a trained counselor. If they are in immediate danger, call 911 .

Signs of Bullying

Bullying occurs intentionally out of the sight of adults. When there are warning signs, they usually involve behavioral and emotional changes.

Signs someone you know is being bullied include:

• They have physical signs like cuts, bruises, or scratches that are not easily explained.
• They try to get out of going to school.
• They suddenly start doing poorly in school.
• They come home moody, sad, teary, depressed, or overly fatigued.
• They have a loss of appetite or develop an eating disorder.
• They appear more stressed or anxious than usual.
• Their belongings come home torn or damaged, or they are missing altogether.
• They experience headaches , nausea , stomach aches , or other physical symptoms.
• They have nightmares , sleep disorders , insomnia , or trouble sleeping.

If You Think Your Child Is Being Bullied

If you think your child is being bullied, it's important to talk to them. They may not ask for help out of fear that it will make things worse. Instead of putting them on the spot, start a general conversation to lead into the topic. Let them know you want to help them. Some suggestions include:

• “There's been a lot of discussion about bullying on the news. Do you know if that happens at your school?"
• “Is there anyone at school you don't like to be around?"
• "Are there any kids at school who are mean to you or other kids?"

Why Do People Bully?

One study indicates that bullies tend to be bullied by their own family, so they may observe and mimic aggressive or angry behavior.

Other reasons may include that they are:

• Lashing out for attention due to lack of attention at home or elsewhere
• Being bullied by their older siblings or adults in their lives (parent, teacher, coach, etc.)
• Elevating their own social status among their peers
• Trying to fit in with others who are bullying
• Insecure, feeling incompetent, or experiencing poor self-esteem

Bullies may feel emotional relief from their own insecurity by dominating others.

Bullies often blame others and don't accept the consequences of their actions.

How to Deal With a Bully

Bullies gain power and control by getting a reaction out of others. They get this reaction by aggravating, frightening, angering, or threatening others.

Some ways to deal with a bully include:

• Get help : Seek help if you're being bullied. This is especially important if it is escalating toward physical threats or actual assaults.
• Respond, don't react : You may feel upset on the inside, but if you can respond calmly instead of reacting emotionally, you maintain control of your emotions. Getting a reaction out of other people is how bullies try to gain power and control.
• Walk away : If safe to do so, walk away from the situation.
• Take a screenshot : If you are cyberbullied, take a screenshot as evidence.
• Strength in numbers : Effective bullying intervention programs assign students into roles of peer supporters, peer mediators, and peer educators.

When You Are the Bully

If you think you may be a bully—or others have accused you of being a bully—consider these questions:

• Have you repeatedly called other people names?
• Have you used your size or tone of voice to intimidate or threaten others?
• Have you made fun of others or said mean things to people about their weight or appearance?
• Have you spread rumors, posted comments, or shared something negative about someone on social media?

If you are mistreating others, you may have been mistreated yourself. It may be helpful to talk to a school counselor, trusted adult, or mental health professional.

The Effects of Bullying

Adults bullied as children are likely to have mental health conditions, including depression , anxiety disorder , and antisocial personality disorder .

Bullying affects bullies negatively as well. In one study, men who bullied and men who were bullied had increased risks of suicide .

Other effects in children and teenagers may include:

• Low self-esteem
• Loss of interest in social activities
• Thoughts of self-harm or suicide
• Development of eating disorders
• Loss of interest in school
• Difficulty focusing on learning
• Poor school attendance
• Lower testing scores and lower grades
• Higher dropout rates

Bullying is any unwanted and aggressive behavior that is intentionally done to hurt another person. It often occurs among children, adolescents, and teens, but it can happen to adults as well. Bullying creates a power imbalance, and it usually occurs repeatedly.

Types of bullying include physical, verbal, social, cyber, racist, and sexual. People who have been bullied may experience effects like depression, anxiety, and low self-esteem.

A Word From Verywell 

Being bullied can make you feel helpless, anxious, and depressed. Support is available to help you address any bullying you are facing. To find resources in your area, contact the  Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline  at  1-800-662-4357  for information.

Studies show bullies often do have depression. Researchers wonder if the bullying behavior is a way of acting out the depression.

In the United States in 2019, 22% of students ages 12–18 experienced bullying. In another study from 2019, 19.5% of students in grades 9–12 indicated they were bullied at school.

A few ways to handle a bully include:

• Try to avoid the bully, and walk or run away from them if it's safe to do so.
• Alert nearby people or an authority figure.
• Try to remain calm.

U.S. Department of Education National Center for Education Statistics. Bullying .

U.S. Department of Health and Human Services Stop Bullying Initiative. What is bullying? .

U.S. Department of Education National Center for Education Statistics. Student reports of bullying: results from the 2017 school crime supplement to the National Crime Victimization Survey .

U.S. Department of Health and Human Services Stop Bullying Initiative. What is cyberbullying? .

Pew Research Center.  A majority of teens have experienced some form of cyberbullying .

Nemours Foundation.  Sexual harassment and sexual bullying .

Stomp Out Bullying Organization. Signs your child is being bullied .

Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry . 2013:70(4):419. doi:10.1001/jamapsychiatry.2013.504

U.S. Department of Health and Human Services Stop Bullying Initiative. Why some youth bully .

Stomp Out Bullying Organization. Why do kids bully? .

Stomp Out Bullying Organization. Are you being bullied? How to deal with bullies .

Menesini, E., Salmivalli, C. Bullying in schools: the state of knowledge and effective interventions . Psychology, Health & Medicine.  2017;22(sup1):240-253. doi:10.1080/13548506.2017.1279740

Jormanainen E, Fröjd S, Marttunen M, Kaltiala-Heino R. Is pubertal timing associated with involvement in bullying in middle adolescence? .  Health Psychol Behav Med . 2014;2(1):144-159. doi:10.1080/21642850.2014.881259

By Michelle C. Brooten-Brooks, LMFT Brooten-Brooks is a licensed marriage and family therapist based in Georgia. She has been covering health and medical topics as a journalist for over 20 years.

Q Methodology as an Innovative Addition to Bullying Researchers’ Methodological Repertoire

• Original Article
• Open access
• Published: 11 May 2022
• Volume 4 , pages 209–219, ( 2022 )

Cite this article

You have full access to this open access article

• Adrian Lundberg   ORCID: orcid.org/0000-0001-8555-6398 1 &
• Lisa Hellström   ORCID: orcid.org/0000-0002-9326-1175 1  

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A Correction to this article was published on 18 July 2022

This article has been updated

The field of bullying research deals with methodological issues and concerns affecting the comprehension of bullying and how it should be defined. For the purpose of designing relevant and powerful bullying prevention strategies, this article argues that instead of pursuing a universal definition of what constitutes bullying, it may be of greater importance to investigate culturally and contextually bound understandings and definitions of bullying. Inherent to that shift is the transition to a more qualitative research approach in the field and a stronger focus on participants’ subjective views and voices. Challenges in qualitative methods are closely connected to individual barriers of hard-to-reach populations and the lack of a necessary willingness to share on the one hand and the required ability to share subjective viewpoints on the other hand. By reviewing and discussing Q methodology, this paper contributes to bullying researchers’ methodological repertoire of less-intrusive methodologies. Q methodology offers an approach whereby cultural contexts and local definitions of bullying can be put in the front. Furthermore, developmentally appropriate intervention and prevention programs might be created based on exploratory Q research and could later be validated through large-scale investigations. Generally, research results based on Q methodology are expected to be useful for educators and policymakers aiming to create a safe learning environment for all children. With regard to contemporary bullying researchers, Q methodology may open up novel possibilities through its status as an innovative addition to more mainstream approaches.

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Introduction

Bullying, internationally recognized as a problematic and aggressive form of behavior, has negative effects, not only for those directly involved but for anybody and in particular children in the surrounding environment (Modin, 2012 ). However, one of the major concerns among researchers in the field of bullying is the type of research methods employed in the studies on bullying behavior in schools. The appropriateness of using quantitative or qualitative research methods rests on the assumption of the researcher and the nature of the phenomena under investigation (Hong & Espelage, 2012 ). There is a need for adults to widen their understanding and maintain a focus on children’s behaviors to be able to provide assistance and support in reducing the amount of stress and anxiety resulting from online and offline victimization (Hellström & Lundberg, 2020 ). A crucial step for widening this understanding is an increased visibility of children’s own viewpoints. When the voices of children, particularly those of victims and perpetrators, but also those of bystanders are heard in these matters, effective support can be designed based specifically on what children want and need rather than what adults interpret and understand to be supporting the child (O’Brien, 2019 ). However, bullying victims and their perpetrators are hard-to-reach populations (Shaghaghi et al., 2011 ; Sydor, 2013 ) for a range of reasons. To name but a few, researchers perennially face difficulties regarding potential participants’ self-identification, the sensitivity of bullying topics, or the power imbalance between them and their young respondents. Furthermore, limited verbal literacy and/or a lack of cognitive ability of some respondents due to age or disability contribute to common methodological issues in the field. Nevertheless, and despite ethical restrictions around the immediate questioning of younger children or children with disabilities that prohibit researchers to perform the assessments with them directly, it would be ethically indefensible to not study a sensitive topic like bullying among vulnerable groups of children. Hence, the research community is responsible for developing valid and reliable methods to explore bullying among different groups of children, where the children’s own voices are heard and taken into account (Hellström, 2019 ). Consequently, this paper aims to contribute to bullying researchers’ methodological repertoire with an additional less-intrusive methodology, particularly suitable for research with hard-to-reach populations.

Historically, the field of bullying and cyberbullying has been dominated by quantitative research approaches, most often with the aim to examine prevalence rates. However, recent research has seen an increase in the use of more qualitative and multiple data collection approaches on how children and youth explain actions and reactions in bullying situations (e.g., Acquadro Maran & Begotti, 2021 ; Eriksen & Lyng, 2018 ; Patton et al., 2017 ). This may be translated into a need to more clearly understand the phenomenon in different contexts. As acknowledged by many researchers, bullying is considerably influenced by the context in which it occurs and the field is benefitting from studying the phenomenon in the setting where all the contextual variables are operating (see, e.g., Acquadro Maran & Begotti, 2021 ; Scheithauer et al., 2016 ; Torrance, 2000 ). Cultural differences in attitudes regarding violence as well as perceptions, attitudes, and values regarding bullying are likely to exist and have an impact when bullying is being studied. For this reason, listening to the voices of children and adolescents when investigating the nature of bullying in different cultures is essential (Hellström & Lundberg, 2020 ; Scheithauer et al., 2016 ).

In addition to studying outcomes or products, bullying research has also emphasized the importance of studying processes (Acquadro Maran & Begotti, 2021 ). Here, the use of qualitative methods allows scholars to not only explore perceptions and understandings of bullying and its characteristics, but also interpret bullying in light of a specific social context, presented from a specific internal point of view. In other words, qualitative approaches may offer methods to understand how people make sense of their experiences of the bullying phenomenon. The processes implemented by a qualitative approach allow researchers to build hypotheses and theories in an inductive way (Atieno, 2009 ). Thus, a qualitative approach can enrich quantitative knowledge of the bullying phenomenon, paying attention to the significance that individuals attribute to situations and their own experiences. It can allow the research and clinical community to better project and implement bullying assessment and prevention programs (Hutson, 2018 ).

Instead of placing qualitative and quantitative approaches in opposition, they can both be useful and complementary, depending on the purpose of the research (Acquadro Maran & Begotti, 2021 ). In their review of mixed methods research on bullying and peer victimization in school, Hong and Espelage ( 2012 ) underlined that instead of using single methods, mixed methods have the advantage of generating a deeper and more complex understanding of the phenomenon. By combining objective data with information about the personal context within which the phenomenon occurs, mixed methods can generate new insights and new perspectives to the research field (Hong & Espelage, 2012 ; Kulig et al., 2008 ; Pellegrini & Long, 2002 ). However, Hong and Espelage ( 2012 ) also argued that mixed methods can lead to divergence and contradictions in findings that may serve as a challenge to researchers. For example, Cowie and Olafsson ( 2000 ) examined the impact of a peer support program to reduce bullying using both quantitative and qualitative data collection methods. While a quantitative approach collecting pre-test and post-test data showed no effects in decreasing bullying, interviews with peer supporters, students, and potential users of the intervention revealed the strength of the program and its positive impact, in light of students and peer supporters. Thus, rather than rejecting the program, the divergence in findings leads to a new rationale for modifying the program and addressing its limits.

Understandably, no single data collection approach is complete but deals with methodological issues and concerns affecting the research field and the comprehension of bullying. To provide a robust foundation for the introduction of an additional methodological perspective in bullying research, common data collection methods and methodological issues are outlined below.

Methodological Issues in Bullying Research

Large-scale cohort studies generating statistical findings often use R-statistics, descriptive analyses, averages, and correlations to estimate and compare prevalence rates of bullying, to explore personality traits of bullies and victims, and the main correlates and predictors of the phenomenon. Nevertheless, large-scale surveys have a harder time examining why bullying happens (O’Brian, 2019 ) and usually do not give voice to study objects’ own unique understanding and experiences (Acquadro Maran & Begotti, 2021 ; Bosacki et al., 2006 ; Woodhead & Faulkner, 2008 ). Other concerns using large-scale surveys include whether a definition is used or the term bullying is operationalized, which components are included in the definition, what cut-off points for determining involvement are being used, the lack of reliability information, and the absence of validity studies (Swearer et al., 2010 ).

Other issues include the validity in cross-cultural comparisons using large-scale surveys. For example, prevalence rates across Europe are often established using standard questionnaires that have been translated into appropriate languages. Comparing four large-scale surveys, Smith et al. ( 2016 ) found that when prevalence rates by country are compared across surveys, there are some obvious discrepancies, which suggest a need to examine systematically how these surveys compare in measuring cross-national differences. Low external validity rates between these studies raise concerns about using these cross-national data sets to make judgments about which countries are higher or lower in victim rates. The varying definitions and words used in bullying research may make it difficult to compare findings from studies conducted in different countries and cultures (Griffin & Gross, 2004 ). However, some argue that the problem seems to be more about inconsistency in the type of assessments (e.g., self-report, nominations) used to measure bullying rather than the varying definition of bullying (Jia & Mikami, 2018 ). When using a single-item approach (e.g., “How often have you been bullied?”) it is not possible to investigate the equivalency of the constructs between countries, which is a crucial precondition for any statistically valid comparison between them (Scheithauer et al., 2016 ). Smith et al. ( 2016 ) conclude that revising definitions and how bullying is translated and expressed in different languages and contexts would help examine comparability between countries.

Interviews, focus groups and the use of vignettes (usually with younger children) can all be regarded as suitable when examining youths’ perceptions of the bullying phenomenon (Creswell, 2013 ; Hellström et al., 2015 ; Hutson, 2018 ). They all allow an exploration of the bullying phenomenon within a social context taking into consideration the voices of children and might solve some of the methodological concerns linked to large-scale surveys. However, these data collection methods are also challenged by individual barriers of hard-to-reach populations (Ellard-Gray et al., 2015 ) and may include the lack of a necessary willingness to share on the one hand and the required ability to share subjective viewpoints on the other hand.

Willingness to Share

In contrast to large-scale surveys requiring large samples of respondents with reasonable literacy skills, interviews, which may rely even heavier on students’ verbal skills, are less plentiful in bullying research. This might at least partially be based on a noteworthy expectation of respondents to be willing to share something. It must be remembered that asking students to express their own or others’ experiences of emotionally charged situations, for example concerning bullying, is particularly challenging (Khanolainen & Semenova, 2020 ) and can be perceived as intrusive by respondents who have not had the opportunity to build a rapport with the researchers. This constitutes a reason why research in this important area is difficult and complex to design and perform. Ethnographic studies may be considered less intrusive, as observations offer a data collection technique where respondents are not asked to share any verbal information or personal experiences. However, ethnographical studies are often challenging due to the amount of time, resources, and competence that are required by the researchers involved (Queirós et al., 2017 ). In addition, ethnographical studies are often used for other purposes than asking participants to share their views on certain topics.

Vulnerable populations often try to avoid participating in research about a sensitive topic that is related to their vulnerable status, as recalling and retelling painful experiences might be distressing. The stigma surrounding bullying may affect children’s willingness to share their personal experiences in direct approaches using the word bullying (Greif & Furlong, 2006 ). For this reason, a single-item approach, in which no definition of bullying is provided, allows researchers to ask follow-up questions about perceptions and contexts and enables participants to enrich the discussion by adjusting their answers based on the suggestions and opinions of others (Jacobs et al., 2015 ). Generally, data collection methods with depersonalization and distancing effects have proven effective in research studying sensitive issues such as abuse, trauma, stigma and so on (e.g., Cromer & Freyd, 2009 ; Hughes & Huby, 2002 ). An interesting point raised by Jacobs and colleagues ( 2015 ) is that a direct approach that asks adolescents if they have ever experienced cyberbullying may lead to a poorer discussion and an underestimation of the phenomenon. This is because perceptions and contexts often differ between persons and because adolescents do not perceive all behaviors as cyberbullying. The same can be true for bullying taking place offline (Hellström et al., 2015 ).

When planning research with children, it is important to consider the immediate research context as it might affect what children will talk about (Barker & Weller, 2003 ; Hill, 2006 ; Punch, 2002 ). In addition to more material aspects, such as the room or medium for a dialog, the potential power imbalance created in an interview situation between an adult researcher and the child under study adds to a potentially limited willingness to share. Sitting in front of an adult interviewer may create situations where children may find it difficult to express their feelings and responses may be given based on perceived expectations (Punch, 2002 ). This effect is expected to be even stronger when studying a sensitive topic like bullying. Therefore, respondents may provide more honest responses when they are unaware that the construct of bullying is being assessed (Swearer et al., 2010 ). Moreover, in research about sensitive topics, building a strong connection with participants (Lyon & Carabelli, 2016 ), characterized by mutual trust, is vital and might overcome the initial hesitation to participate and share personal accounts. Graphic vignettes have successfully been used as such unique communication bridges to collect detailed accounts of bullying experiences (Khanolainen & Semenova, 2020 ). However, some reluctance to engage has been reported even in art-based methods, usually known to be effective in research with verbally limited participants (Bagnoli, 2009 ; Vacchelli, 2018 ) or otherwise hard-to-reach populations (Goopy & Kassan, 2019 ). Most commonly, participants might not see themselves as creative or artistic enough (Scherer, 2016 ). In sum, the overarching challenging aspect of art-based methods related to a limited willingness to share personal information is an often-required production of some kind.

Ability to Share

Interviews as a data collection method demand adequate verbal literacy skills for participants to take part and to make their voices heard. This may be challenging especially for younger children or children with different types of disabilities. There is a wide research gap in exploring the voices of younger children (de Leeuw et al., 2020 ) and children with disabilities (Hellström, 2019 ) in bullying research. Students’ conceptualization of bullying behavior changes with age, as there are suggestions that younger students tend to focus more on physical forms of bullying (such as fighting), while older students include a wider variety of behaviors in their view of bullying, such as verbal aggression and social exclusion (Hellström & Lundberg, 2020 ; Monks & Smith, 2006 ; Smith et al., 2002 ; Hellström et al., 2015 ). This suggests that cognitive development may allow older students to conceptualize bullying along a number of dimensions (Monks & Smith, 2006 ). Furthermore, the exclusion of the voices of children with disabilities in bullying research is debated. It is discussed that the symptoms and characteristics of disabilities such as Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD), i.e., difficulties understanding the thoughts, emotions, reactions, and behaviors of others, which makes them the ideal target for bullying may also make it hard for them to perceive, verbalize and report bullying and victimization in a reliable and valid manner (Slaughter et al., 2002 ). It may also be difficult for children with ASD to differentiate between playful teasing among friends and hurtful teasing. While many argue that children with ASD are unreliable respondents of victimization, under-reporting using parental and teacher reports has been shown in research on bullying (Waters et al., 2003 ; Bradshaw et al., 2007 ) and child maltreatment (Compier-de Block et al., 2017 ).

This Paper’s Contribution

The present paper contributes to this special issue about qualitative school bullying and cyberbullying research by reviewing and discussing Q methodology as an innovative addition to more mainstream approaches in the field. Despite the fact that Q methodology had been proclaimed as “especially valuable […] in educational psychology” (Stephenson, 1935 , p. 297) nearly 90 years ago, the approach has only relatively recently been described as an up-and-coming methodological choice of educational researchers interested in participants’ subjective views (Lundberg et al., 2020 ). Even though, Q enables researchers to investigate and uncover first-person accounts, characterized by a high level of qualitative detail in its narrative description, only few educational studies have applied Q methodology to investigate the subject of bullying (see Camodeca & Coppola, 2016 ; Ey & Spears, 2020 ; Hellström & Lundberg, 2020 ; Wester & Trepal, 2004 ). Within the wider field of bullying, Q methodology has also been used to investigate workplace bullying in hospitals (Benmore et al., 2018 ) and nursing units (Choi & Lee, 2019 ). By responding to common methodological issues outlined earlier, the potential Q methodology might have for bullying research is exemplified. A particular focus is thereby put on capturing respondents’ subjective viewpoints through its less-intrusive data collection technique. The present paper closes by discussing implications for practice and suggesting future directions for Q methodological bullying and cyberbullying research, in particular with hard-to-reach populations.

An Introduction to Q Methodology

Q as a methodology represents a larger conceptual and philosophical framework, which is by no means novel. However, the methodology has largely been marginalized since its invention in the 1930s by William Stephenson (Brown, 2006 ). As a research technique, it broadly consists of three stages that each can be split into a set of steps (see Fig.  1 ); (1) carefully constructing a data collection instrument, (2) collecting data, and (3) analyzing and interpreting data. The central, and therefore also best-known feature of Q methodology is Q sorting to collect data in the form of individual Q sorts. Participants thereby rank order a sample of self-referent stimuli along a continuum and in accordance with a central condition of instruction; for example, children might be asked to what extent particular scenarios describe bullying situations (Hellström & Lundberg, 2020 ) or they might be instructed to sort illustrated ways to resolve social exclusion according to the single face-valid dimension of “least preferred to most preferred” (de Leeuw et al., 2019 ). As soon as all items are placed on a most often bell-shaped distribution grid (see Fig.  2 ), participants might be asked to elaborate on their item placement to add a further layer of qualitative data. Such so-called post-sorting activities might include written annotations of items placed at the ends of the continuum or form the structure for interviews (Shemmings & Ellingsen, 2012 ).

Three stages and six steps of a Q methodological research process (adapted from Lundberg et al., 2020 )

A vertical distribution grid with two examples of face-valid dimensions. This rather small distribution is designed for a 16-item Q sample and therefore contains 16 slots to be filled

For participants to provide their subjective viewpoint toward a specific topic in the form of a Q sort, researchers need to construct the data collection instrument, called Q sample. Such a set of stimulus items is a representative sample from all possible items concerning the topic, which in the technical language in Q methodology is called concourse (Brown, 1980 ). The development of such a concourse about the topic at hand might stem from a wide range of sources, including academic literature, policy documents, informal discussions, or media (Watts & Stenner, 2012 ). Moreover, in a participatory research fashion, participants’ statements can be used verbatim to populate the concourse. This way, children’s own words and voices are part of the data collection instrument. A sophisticated structuring process then guides the researchers in selecting a Q sample from all initial statements in the concourse (Brown et al., 2019 ). In Hellström & Lundberg ( 2020 ), a literature review on findings and definitions of bullying, stemming from qualitative and quantitative research, provided the initial concourse. A matrix consisting of different modes, types, and contexts of bullying supported the construction of the final Q sample.

As a student and assistant of Charles Spearman, Q’s inventor Stephenson was well-informed about R-methodological factor analysis based on correlating traits. The British physicist-psychologist however inverted the procedure and thereby suggested correlating persons to study human behavior (Stephenson, 1935 , 1953 ). A detailed description of the statistical procedure of Q factor analysis is outside the scope of this article, especially as the focus of this special issue is put on qualitative research methods. In addition, with its focus on producing quantifiable data from highly subjective viewpoints (Duncan & Owens, 2011 ), it is safe to say that Q methodology is more often treated as a qualitative methodology with quantitative features than the other way around. Nevertheless, it is important to note that through factor analysis, individual viewpoints are clustered into so-called factors, representing shared viewpoints if they sufficiently correlate (see Fig.  3 ). In that sense, no outside criterion is applied to respondents’ subjective views and groups of similar sorts (factors/viewpoints) are not logically constructed by researchers. Instead, they inductively emerge through quantitative analysis, which helps “in learning how the subject, not the observer, understands and reacts to items” (Brown, 1980 , p. 191). This procedure allowed Hellström & Lundberg ( 2020 ) to describe two age-related definitions of bullying. Older students in particular perceived offline bullying as more severe than online bullying and their younger peers were mostly concerned about bullying situations taking place in a private setting.

A simplified illustration of Q factor analysis (step 5). Arrow A represents the statistical correlation of all collected individual viewpoints. Arrow B represents inverted factor analysis as the data condensation technique resulting in a manageable number of shared viewpoints

Despite its quantitative analysis, participant selection in Q methodology is largely in line with purposive sampling with small numbers. It, therefore, represents a major difference to R methodological research, where larger opportunity samples are desired. In Q methodology, participants are selected strategically in line with those who might likely “express a particularly interesting or pivotal point of view” (Watts & Stenner, 2012 , p. 71). Investigating a large number of similar respondents might therefore simply lead to more participants correlating with the same shared viewpoint and not necessarily add new viewpoints. In recent educational Q research, the average number of participants is 37 (Lundberg et al., 2020 ). Many studies have however been successfully conducted with considerably fewer, as for example illustrated by Benmore et al. ( 2018 ), who described three distinctive groups within their sample of 12 participants.

To illustrate Q methodology in bullying research, our small scale and exploratory study published in Educational Research (Hellström & Lundberg, 2020 ) serves as a practical example. The purpose of that study was to investigate definitions of bullying from young people’s perspectives and was guided by the following research question: What are students’ subjective viewpoints on bullying behavior? . In Table 1 , we describe the methodological steps introduced in Fig.  1 .

Q Methodology’s Response to the Methodological Issues Outlined Above

Above, methodological issues have been structured according to participants’ willingness and ability to share their subjective viewpoints and lived experiences. In order to respond to those, the present section focuses on Q methodology’s built-in features. A particularly important component is Q sorting as the central data collection technique that facilitates participants’ communicability of their subjectivity.

Engaging participants in a card sorting activity encourages students to express their viewpoints and thereby making their voices heard in a less-intrusive way, despite being cognitively engaging. Because they are asked to rank-order a predetermined sample of items, ideally in accordance with a carefully selected condition of instruction, they do not need to report or disclose their own personal experiences and are not obliged to actively create anything, as criticized in arts-based research. In that sense, Q methodology can be seen as a method to collect sensitive data in a more depersonalized way. This provides the basis to find a vital “balance between protecting the child and at the same time allowing access to important information” (Thorsen & Størksen, 2010 , p. 9), which is of particular importance for research about emotionally charged situations or sensitive topics as it is often the case with bullying (Ellingsen et al., 2014 ). Sharing their view through a fixed collection of items certainly makes participation in research for young children or otherwise hard-to-reach respondents less intimidating and results can be expected to be more truthful.

In comparison to researchers applying ethnographical approaches, who immerse themselves into the studied context to understand and document patterns of social behavior and interaction in a less intrusive way, Q methodologists are not expected to observe their participants. Even though the purpose of these approaches is different, being part of the culture under investigation or at least involving community partners in Q methodological research can still be useful for at least two reasons. As mentioned in Table 1 featuring the study by Hellström & Lundberg ( 2020 ), the pupils’ physical education and health teacher guided an exploratory and informal discussion and thereby provided valuable insights into the participants’ lifeworld that informed the Q sample. In addition to better tailoring the sample to the participants and making them feel seen and heard, the community partner could help build a positive rapport between participants and researchers, which otherwise requires much work. During the actual data collection exercise, participants were already familiar with the topic, well-informed about the research project, and perceived the sorting activity as an integral part of their lesson.

The play-like character of Q sorting has as well been reported as a positive influence on respondents’ motivation to participate (de Leeuw et al., 2019 ) and Wright ( 2013 ) mentions the engaging atmosphere created between the sorter and the researcher. The combination of these features allows assuming that obtaining participants’ viewpoint through Q methodology is less threatening than for example sitting in front of an interviewer and providing on-spot oral responses about a sensitive topic.

Q sorting as a data collection instrument represents a major advantage for Q methodological research with participants that do not (yet) possess sufficient verbal literacy and/or cognitive ability to process receptive or expressive language. To illustrate, two features are outlined here: first the flexibility of the Q sample, say the set of stimuli and second the fact that primary data collection in Q methodology is based on a silent activity.

Written statements are undoubtedly the most common type of items used in Q methodology and the number of such in a Q sample greatly varies. In recent research reporting from compulsory education settings, the average Q sample consists of about 40 items (Lundberg et al., 2020 ). In addition to applying a smaller set of items, their complexity can easily be adapted in line with participants’ receptive literacy skills and their developmental stage to facilitate understanding. Statements can for example be shortened or they can start identically to make the activity less taxing (Watts & Stenner, 2012 ). A different approach to cater to limited verbal literacy is the use of images instead of written statements. Constructing a visual Q sample might be more challenging for the researcher, in particular, if images are carefully selected and culturally tailored, meaning that they are clear, appealing and without too many details (Thorsen & Størksen, 2010 ). It might nevertheless be worth it, as such items provide a powerful tool to elicit viewpoints from otherwise marginalized or hard-to-reach research participants. Combes and colleagues ( 2004 ) for example, created a 37-item-Q sample with intellectually disabled participants’ own pictures to evaluate the planning of activities and de Leeuw et al. ( 2019 ) have used 15 images of hypothetical scenarios of social exclusion in a study with primary school pupils. Furthermore, as illustrated by Allgood and Svennungsen ( 2008 ) who photographed their participant’s own sculptures, Q samples consisting of objects (e.g., toys) or symbols (emojis) might be other options to investigate issues about bullying and cyberbullying without using text.

In addition to adaptations to the data collection instrument, the sorting process is usually carefully introduced and illustrated. Researchers might want to go through the entire Q sample to ensure the participants are able to discriminate each item (Combes et al., 2004 ). Even with adult participants without any cognitive impairments, it is suggested to pre-sort items into three provisional categories (Watts & Stenner, 2012 ). Two categories represent the respective ends of the continuum in the distribution grid and might be labeled and. Any items the sorter feels insecure or neutral about, are moved to the third category, which receives a question mark (?) for the sake of this exercise. During the actual rank-ordering process, the participants start to allocate items to one of the ends of the continuum (the top of the distribution grid in Fig.  2 ) with cards from the ☺ category and work themselves toward the center of the distribution grid. The process continues with items in the ☹ category, which are placed from the opposite end of the continuum toward the center. Any free spots are then filled with the remaining items in the (?) category. The graphic display of their viewpoint has been experienced as enabling for self-reflection (Combes et al., 2004 ) and might be utilized for a further discussion about the topic, for example as part of teacher workshops (Ey & Spears, 2020 ).

Meeting children at an appropriate cognitive level through adaptations of the data collection instrument and procedure, is not only a promising and important ethical decision in order to show young participants the respect they deserve (Thorsen & Størsken, 2010 ), but makes the sorting procedure a pleasant experience for the participants (John et al., 2014 ). Unsurprisingly, Q methodology has been described as a respectful, person-centered, and therefore child-friendly approach (Hughes, 2016 ).

Limitations

Despite its potential for bullying research, Q methodology has its limitations. The approach is still relatively unknown in the field of bullying research and academic editors’ and reviewers’ limited familiarity with it can make publishing Q methodological research challenging. Notwithstanding the limitation of not being based on a worked example, the contribution of the present paper hopefully fulfills some of the needed spadework toward greater acceptability within and beyond a field, which has only seen a limited number of Q methodological research studies. Because the careful construction of a well-balanced Q sample is time-consuming and prevents spontaneous research activities, a core set of items could be created to shorten the research process and support the investigation of what bullying means to particular groups of people. Such a Q sample would then have to be culturally tailored to fit local characteristics. Finally, the present paper is limited in our non-comprehensive selection of data collection methods as points of comparison when arguing for a more intensive focus on Q methodology for bullying research.

Future Research Directions

The results of Q methodological studies based on culturally tailored core Q samples would allow the emergence of local definitions connected to the needs of the immediate society or school context. As illustrated by Hellström & Lundberg ( 2020 ), even within the same school context, and with the same data collection instrument (Q sample), Q methodology yielded different, age-related definitions of bullying. Or in Wester and Trepal ( 2004 ), Q methodological analysis revealed more perceptions and opinions about bullying than researchers usually mention. Hence, Q methodology offers a robust and strategic approach that can foreground cultural contexts and local definitions of bullying. If desired, exploratory small-scale Q research might later be validated through large-scale investigations. A further direction for future research in the field of bullying research is connected to the great potential of visual Q samples to further minimize research participation restrictions for respondents with limited verbal or cognitive abilities.

Implications for Practice

When designing future bullying prevention strategies, Q methodology presents a range of benefits to take into consideration. The approach offers a robust way to collect viewpoints about bullying without asking participants to report their own experiences. The highly flexible sorting activity further represents a method to investigate bullying among groups that are underrepresented in bullying research, such as preschool children (Camodeca & Coppola, 2016 ). This is of great importance, as tackling bullying at an early age can prevent its escalation (Alsaker & Valkanover, 2001 ; Storey & Slaby, 2013 ). Making the voices of the hard-to-reach heard in an unrestricted way and doing research with them instead of about them (de Leeuw et al., 2019 ; Goopy & Kassan, 2019 ) is expected to enable them to be part of discussions about their own well-being. By incorporating social media platforms, computer games, or other contextually important activities when designing a Q sample, the sorting of statements in Hellström & Lundberg, ( 2020 ) turned into a highly relevant activity, clearly connected to the reality of the students. As a consequence, resulting policy creation processes based on such exploratory studies should lead to more effective interventions and bullying prevention programs confirming the conclusion by Ey and Spears ( 2020 ) that Q methodology served as a great model to develop and implement context-specific programs. Due to the enhanced accountability and involvement of children’s own voices, we foresee a considerable increase in implementation and success rates of such programs. Moreover, Q methodology has been suggested as an effective technique to evaluate expensive anti-bullying interventions (Benmore et al., 2018 ). Generally, research results based on exploratory Q methodology that quantitatively condensates rich data and makes commonalities and diversities among participants emerge through inverted factor analysis are expected to be useful for educators and policymakers aiming to create a safe learning environment for all children. At the same time, Q methodology does not only provide an excellent ground for participatory research, but is also highly cost-efficient due to its status as a small-sample approach. This might be particularly attractive, when neither time nor resources for other less-intrusive methodological approaches, such as for example ethnography, are available. Due to its highly engaging aspect and great potential for critical personal reflection, Q sorting might be applied in classes regardless of representing a part of a research study or simply as a learning tool (Duncan & Owens, 2011 ). Emerging discussions are expected to facilitate and mediate crucial dialogs and lead toward collective problem-solving among children.

The use of many different terminologies and different cultural understandings, including meaning, comprehension, and operationalization, indicates that bullying is a concept that is difficult to define and subject to cultural influences. For the purpose of designing relevant and powerful bullying prevention strategies, this paper argues that instead of pursuing a universal definition of what constitutes bullying, it may be of greater importance to investigate culturally and contextually bound understandings and definitions of bullying. Although the quest for cultural and contextual bound definitions is not new in bullying research, this paper offers an additional method, Q methodology, to capture participants’ subjective views and voices. Since particularly the marginalized and vulnerable participants, for example, bullying victims, are usually hard to reach, bullying researchers might benefit from a methodological repertoire enriched with a robust approach that is consistent with changes in methodological and epistemological thinking in the field. In this paper, we have argued that built-in features of Q methodology respond to perennial challenges in bullying research connected to a lack of willingness and limited ability to share among participants as well as studying bullying as a culturally sensitive topic. In summary, we showcased how Q methodology allows a thorough and less-intrusive investigation of what children perceive to be bullying and believe that Q methodology may open up novel possibilities for contemporary bullying researchers through its status as an innovative addition to more mainstream approaches.

Availability of Data and Material

Not applicable.

Code Availability

Change history, 18 july 2022.

A Correction to this paper has been published: https://doi.org/10.1007/s42380-022-00135-9

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Lundberg, A., Hellström, L. Q Methodology as an Innovative Addition to Bullying Researchers’ Methodological Repertoire. Int Journal of Bullying Prevention 4 , 209–219 (2022). https://doi.org/10.1007/s42380-022-00127-9

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What the data says about abortion in the U.S.

Pew Research Center has conducted many surveys about abortion over the years, providing a lens into Americans’ views on whether the procedure should be legal, among a host of other questions.

In a  Center survey  conducted nearly a year after the Supreme Court’s June 2022 decision that  ended the constitutional right to abortion , 62% of U.S. adults said the practice should be legal in all or most cases, while 36% said it should be illegal in all or most cases. Another survey conducted a few months before the decision showed that relatively few Americans take an absolutist view on the issue .

Find answers to common questions about abortion in America, based on data from the Centers for Disease Control and Prevention (CDC) and the Guttmacher Institute, which have tracked these patterns for several decades:

How many abortions are there in the U.S. each year?

How has the number of abortions in the u.s. changed over time, what is the abortion rate among women in the u.s. how has it changed over time, what are the most common types of abortion, how many abortion providers are there in the u.s., and how has that number changed, what percentage of abortions are for women who live in a different state from the abortion provider, what are the demographics of women who have had abortions, when during pregnancy do most abortions occur, how often are there medical complications from abortion.

This compilation of data on abortion in the United States draws mainly from two sources: the Centers for Disease Control and Prevention (CDC) and the Guttmacher Institute, both of which have regularly compiled national abortion data for approximately half a century, and which collect their data in different ways.

The CDC data that is highlighted in this post comes from the agency’s “abortion surveillance” reports, which have been published annually since 1974 (and which have included data from 1969). Its figures from 1973 through 1996 include data from all 50 states, the District of Columbia and New York City – 52 “reporting areas” in all. Since 1997, the CDC’s totals have lacked data from some states (most notably California) for the years that those states did not report data to the agency. The four reporting areas that did not submit data to the CDC in 2021 – California, Maryland, New Hampshire and New Jersey – accounted for approximately 25% of all legal induced abortions in the U.S. in 2020, according to Guttmacher’s data. Most states, though,  do  have data in the reports, and the figures for the vast majority of them came from each state’s central health agency, while for some states, the figures came from hospitals and other medical facilities.

Discussion of CDC abortion data involving women’s state of residence, marital status, race, ethnicity, age, abortion history and the number of previous live births excludes the low share of abortions where that information was not supplied. Read the methodology for the CDC’s latest abortion surveillance report , which includes data from 2021, for more details. Previous reports can be found at  stacks.cdc.gov  by entering “abortion surveillance” into the search box.

For the numbers of deaths caused by induced abortions in 1963 and 1965, this analysis looks at reports by the then-U.S. Department of Health, Education and Welfare, a precursor to the Department of Health and Human Services. In computing those figures, we excluded abortions listed in the report under the categories “spontaneous or unspecified” or as “other.” (“Spontaneous abortion” is another way of referring to miscarriages.)

Guttmacher data in this post comes from national surveys of abortion providers that Guttmacher has conducted 19 times since 1973. Guttmacher compiles its figures after contacting every known provider of abortions – clinics, hospitals and physicians’ offices – in the country. It uses questionnaires and health department data, and it provides estimates for abortion providers that don’t respond to its inquiries. (In 2020, the last year for which it has released data on the number of abortions in the U.S., it used estimates for 12% of abortions.) For most of the 2000s, Guttmacher has conducted these national surveys every three years, each time getting abortion data for the prior two years. For each interim year, Guttmacher has calculated estimates based on trends from its own figures and from other data.

The latest full summary of Guttmacher data came in the institute’s report titled “Abortion Incidence and Service Availability in the United States, 2020.” It includes figures for 2020 and 2019 and estimates for 2018. The report includes a methods section.

In addition, this post uses data from StatPearls, an online health care resource, on complications from abortion.

An exact answer is hard to come by. The CDC and the Guttmacher Institute have each tried to measure this for around half a century, but they use different methods and publish different figures.

The last year for which the CDC reported a yearly national total for abortions is 2021. It found there were 625,978 abortions in the District of Columbia and the 46 states with available data that year, up from 597,355 in those states and D.C. in 2020. The corresponding figure for 2019 was 607,720.

The last year for which Guttmacher reported a yearly national total was 2020. It said there were 930,160 abortions that year in all 50 states and the District of Columbia, compared with 916,460 in 2019.

• How the CDC gets its data: It compiles figures that are voluntarily reported by states’ central health agencies, including separate figures for New York City and the District of Columbia. Its latest totals do not include figures from California, Maryland, New Hampshire or New Jersey, which did not report data to the CDC. ( Read the methodology from the latest CDC report .)
• How Guttmacher gets its data: It compiles its figures after contacting every known abortion provider – clinics, hospitals and physicians’ offices – in the country. It uses questionnaires and health department data, then provides estimates for abortion providers that don’t respond. Guttmacher’s figures are higher than the CDC’s in part because they include data (and in some instances, estimates) from all 50 states. ( Read the institute’s latest full report and methodology .)

While the Guttmacher Institute supports abortion rights, its empirical data on abortions in the U.S. has been widely cited by  groups  and  publications  across the political spectrum, including by a  number of those  that  disagree with its positions .

These estimates from Guttmacher and the CDC are results of multiyear efforts to collect data on abortion across the U.S. Last year, Guttmacher also began publishing less precise estimates every few months , based on a much smaller sample of providers.

The figures reported by these organizations include only legal induced abortions conducted by clinics, hospitals or physicians’ offices, or those that make use of abortion pills dispensed from certified facilities such as clinics or physicians’ offices. They do not account for the use of abortion pills that were obtained  outside of clinical settings .

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The annual number of U.S. abortions rose for years after Roe v. Wade legalized the procedure in 1973, reaching its highest levels around the late 1980s and early 1990s, according to both the CDC and Guttmacher. Since then, abortions have generally decreased at what a CDC analysis called  “a slow yet steady pace.”

Guttmacher says the number of abortions occurring in the U.S. in 2020 was 40% lower than it was in 1991. According to the CDC, the number was 36% lower in 2021 than in 1991, looking just at the District of Columbia and the 46 states that reported both of those years.

(The corresponding line graph shows the long-term trend in the number of legal abortions reported by both organizations. To allow for consistent comparisons over time, the CDC figures in the chart have been adjusted to ensure that the same states are counted from one year to the next. Using that approach, the CDC figure for 2021 is 622,108 legal abortions.)

There have been occasional breaks in this long-term pattern of decline – during the middle of the first decade of the 2000s, and then again in the late 2010s. The CDC reported modest 1% and 2% increases in abortions in 2018 and 2019, and then, after a 2% decrease in 2020, a 5% increase in 2021. Guttmacher reported an 8% increase over the three-year period from 2017 to 2020.

As noted above, these figures do not include abortions that use pills obtained outside of clinical settings.

Guttmacher says that in 2020 there were 14.4 abortions in the U.S. per 1,000 women ages 15 to 44. Its data shows that the rate of abortions among women has generally been declining in the U.S. since 1981, when it reported there were 29.3 abortions per 1,000 women in that age range.

The CDC says that in 2021, there were 11.6 abortions in the U.S. per 1,000 women ages 15 to 44. (That figure excludes data from California, the District of Columbia, Maryland, New Hampshire and New Jersey.) Like Guttmacher’s data, the CDC’s figures also suggest a general decline in the abortion rate over time. In 1980, when the CDC reported on all 50 states and D.C., it said there were 25 abortions per 1,000 women ages 15 to 44.

That said, both Guttmacher and the CDC say there were slight increases in the rate of abortions during the late 2010s and early 2020s. Guttmacher says the abortion rate per 1,000 women ages 15 to 44 rose from 13.5 in 2017 to 14.4 in 2020. The CDC says it rose from 11.2 per 1,000 in 2017 to 11.4 in 2019, before falling back to 11.1 in 2020 and then rising again to 11.6 in 2021. (The CDC’s figures for those years exclude data from California, D.C., Maryland, New Hampshire and New Jersey.)

The CDC broadly divides abortions into two categories: surgical abortions and medication abortions, which involve pills. Since the Food and Drug Administration first approved abortion pills in 2000, their use has increased over time as a share of abortions nationally, according to both the CDC and Guttmacher.

The majority of abortions in the U.S. now involve pills, according to both the CDC and Guttmacher. The CDC says 56% of U.S. abortions in 2021 involved pills, up from 53% in 2020 and 44% in 2019. Its figures for 2021 include the District of Columbia and 44 states that provided this data; its figures for 2020 include D.C. and 44 states (though not all of the same states as in 2021), and its figures for 2019 include D.C. and 45 states.

Guttmacher, which measures this every three years, says 53% of U.S. abortions involved pills in 2020, up from 39% in 2017.

Two pills commonly used together for medication abortions are mifepristone, which, taken first, blocks hormones that support a pregnancy, and misoprostol, which then causes the uterus to empty. According to the FDA, medication abortions are safe  until 10 weeks into pregnancy.

Surgical abortions conducted  during the first trimester  of pregnancy typically use a suction process, while the relatively few surgical abortions that occur  during the second trimester  of a pregnancy typically use a process called dilation and evacuation, according to the UCLA School of Medicine.

In 2020, there were 1,603 facilities in the U.S. that provided abortions,  according to Guttmacher . This included 807 clinics, 530 hospitals and 266 physicians’ offices.

While clinics make up half of the facilities that provide abortions, they are the sites where the vast majority (96%) of abortions are administered, either through procedures or the distribution of pills, according to Guttmacher’s 2020 data. (This includes 54% of abortions that are administered at specialized abortion clinics and 43% at nonspecialized clinics.) Hospitals made up 33% of the facilities that provided abortions in 2020 but accounted for only 3% of abortions that year, while just 1% of abortions were conducted by physicians’ offices.

Looking just at clinics – that is, the total number of specialized abortion clinics and nonspecialized clinics in the U.S. – Guttmacher found the total virtually unchanged between 2017 (808 clinics) and 2020 (807 clinics). However, there were regional differences. In the Midwest, the number of clinics that provide abortions increased by 11% during those years, and in the West by 6%. The number of clinics  decreased  during those years by 9% in the Northeast and 3% in the South.

The total number of abortion providers has declined dramatically since the 1980s. In 1982, according to Guttmacher, there were 2,908 facilities providing abortions in the U.S., including 789 clinics, 1,405 hospitals and 714 physicians’ offices.

The CDC does not track the number of abortion providers.

In the District of Columbia and the 46 states that provided abortion and residency information to the CDC in 2021, 10.9% of all abortions were performed on women known to live outside the state where the abortion occurred – slightly higher than the percentage in 2020 (9.7%). That year, D.C. and 46 states (though not the same ones as in 2021) reported abortion and residency data. (The total number of abortions used in these calculations included figures for women with both known and unknown residential status.)

The share of reported abortions performed on women outside their state of residence was much higher before the 1973 Roe decision that stopped states from banning abortion. In 1972, 41% of all abortions in D.C. and the 20 states that provided this information to the CDC that year were performed on women outside their state of residence. In 1973, the corresponding figure was 21% in the District of Columbia and the 41 states that provided this information, and in 1974 it was 11% in D.C. and the 43 states that provided data.

In the District of Columbia and the 46 states that reported age data to  the CDC in 2021, the majority of women who had abortions (57%) were in their 20s, while about three-in-ten (31%) were in their 30s. Teens ages 13 to 19 accounted for 8% of those who had abortions, while women ages 40 to 44 accounted for about 4%.

The vast majority of women who had abortions in 2021 were unmarried (87%), while married women accounted for 13%, according to  the CDC , which had data on this from 37 states.

In the District of Columbia, New York City (but not the rest of New York) and the 31 states that reported racial and ethnic data on abortion to  the CDC , 42% of all women who had abortions in 2021 were non-Hispanic Black, while 30% were non-Hispanic White, 22% were Hispanic and 6% were of other races.

Looking at abortion rates among those ages 15 to 44, there were 28.6 abortions per 1,000 non-Hispanic Black women in 2021; 12.3 abortions per 1,000 Hispanic women; 6.4 abortions per 1,000 non-Hispanic White women; and 9.2 abortions per 1,000 women of other races, the  CDC reported  from those same 31 states, D.C. and New York City.

For 57% of U.S. women who had induced abortions in 2021, it was the first time they had ever had one,  according to the CDC.  For nearly a quarter (24%), it was their second abortion. For 11% of women who had an abortion that year, it was their third, and for 8% it was their fourth or more. These CDC figures include data from 41 states and New York City, but not the rest of New York.

Nearly four-in-ten women who had abortions in 2021 (39%) had no previous live births at the time they had an abortion,  according to the CDC . Almost a quarter (24%) of women who had abortions in 2021 had one previous live birth, 20% had two previous live births, 10% had three, and 7% had four or more previous live births. These CDC figures include data from 41 states and New York City, but not the rest of New York.

The vast majority of abortions occur during the first trimester of a pregnancy. In 2021, 93% of abortions occurred during the first trimester – that is, at or before 13 weeks of gestation,  according to the CDC . An additional 6% occurred between 14 and 20 weeks of pregnancy, and about 1% were performed at 21 weeks or more of gestation. These CDC figures include data from 40 states and New York City, but not the rest of New York.

About 2% of all abortions in the U.S. involve some type of complication for the woman , according to an article in StatPearls, an online health care resource. “Most complications are considered minor such as pain, bleeding, infection and post-anesthesia complications,” according to the article.

The CDC calculates  case-fatality rates for women from induced abortions – that is, how many women die from abortion-related complications, for every 100,000 legal abortions that occur in the U.S .  The rate was lowest during the most recent period examined by the agency (2013 to 2020), when there were 0.45 deaths to women per 100,000 legal induced abortions. The case-fatality rate reported by the CDC was highest during the first period examined by the agency (1973 to 1977), when it was 2.09 deaths to women per 100,000 legal induced abortions. During the five-year periods in between, the figure ranged from 0.52 (from 1993 to 1997) to 0.78 (from 1978 to 1982).

The CDC calculates death rates by five-year and seven-year periods because of year-to-year fluctuation in the numbers and due to the relatively low number of women who die from legal induced abortions.

In 2020, the last year for which the CDC has information , six women in the U.S. died due to complications from induced abortions. Four women died in this way in 2019, two in 2018, and three in 2017. (These deaths all followed legal abortions.) Since 1990, the annual number of deaths among women due to legal induced abortion has ranged from two to 12.

The annual number of reported deaths from induced abortions (legal and illegal) tended to be higher in the 1980s, when it ranged from nine to 16, and from 1972 to 1979, when it ranged from 13 to 63. One driver of the decline was the drop in deaths from illegal abortions. There were 39 deaths from illegal abortions in 1972, the last full year before Roe v. Wade. The total fell to 19 in 1973 and to single digits or zero every year after that. (The number of deaths from legal abortions has also declined since then, though with some slight variation over time.)

The number of deaths from induced abortions was considerably higher in the 1960s than afterward. For instance, there were 119 deaths from induced abortions in  1963  and 99 in  1965 , according to reports by the then-U.S. Department of Health, Education and Welfare, a precursor to the Department of Health and Human Services. The CDC is a division of Health and Human Services.

Note: This is an update of a post originally published May 27, 2022, and first updated June 24, 2022.

Support for legal abortion is widespread in many countries, especially in Europe

Nearly a year after roe’s demise, americans’ views of abortion access increasingly vary by where they live, by more than two-to-one, americans say medication abortion should be legal in their state, most latinos say democrats care about them and work hard for their vote, far fewer say so of gop, positive views of supreme court decline sharply following abortion ruling, most popular.

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Understanding Alternative Bullying Perspectives Through Research Engagement With Young People

Associated data.

The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.

Bullying research has traditionally been dominated by largescale cohort studies focusing on the personality traits of bullies and victims. These studies focus on bullying prevalence, risk and protective factors, and negative outcomes. A limitation of this approach is that it does not explain why bullying happens. Qualitative research can help shed light on these factors. This paper discusses the findings from four mainly qualitative research projects including a systematic review and three empirical studies involving young people to various degrees within the research process as respondents, co-researchers and commissioners of research. Much quantitative research suggests that young people are a homogenous group and through the use of surveys and other large scale methods, generalizations can be drawn about how bullying is understood and how it can be dealt with. Findings from the studies presented in this paper, add to our understanding that young people appear particularly concerned about the role of wider contextual and relational factors in deciding if bullying has happened. These studies underscore the relational aspects of definitions of bullying and, how the dynamics of young people’s friendships can shift what is understood as bullying or not. Moreover, to appreciate the relational and social contexts underpinning bullying behaviors, adults and young people need to work together on bullying agendas and engage with multiple definitions, effects and forms of support. Qualitative methodologies, in particular participatory research opens up the complexities of young lives and enables these insights to come to the fore. Through this approach, effective supports can be designed based on what young people want and need rather than those interpreted as supportive through adult understanding.

Introduction

Research on school bullying has developed rapidly since the 1970s. Originating in social and psychological research in Norway, Sweden, and Finland, this body of research largely focusses on individualized personality traits of perpetrators and victims ( Olweus, 1995 ). Global interest in this phenomenon subsequently spread and bullying research began in the United Kingdom, Australia, and the United States ( Griffin and Gross, 2004 ). Usually quantitative in nature, many studies examine bullying prevalence, risk and protective factors, and negative outcomes ( Patton et al., 2017 ). Whilst quantitative research collates key demographic information to show variations in bullying behaviors and tendencies, this dominant bullying literature fails to explain why bullying happens. Nor does it attempt to understand the wider social contexts in which bullying occurs. Qualitative research on the other hand, in particular participatory research, can help shed light on these factors by highlighting the complexities of the contextual and relational aspects of bullying and the particular challenges associated with addressing it. Patton et al. (2017) in their systematic review of qualitative methods used in bullying research, found that the use of such methods can enhance academic and practitioner understanding of bullying.

In this paper, I draw on four bullying studies; one systematic review of both quantitative and qualitative research ( O’Brien, 2009 ) and three empirical qualitative studies ( O’Brien and Moules, 2010 ; O’Brien, 2016 , 2017 ) (see Table 1 below). I discuss how participatory research methodologies, to varying degrees, were used to facilitate bullying knowledge production among teams of young people and adults. Young people in these presented studies were consequently involved in the research process along a continuum of involvement ( Bragg and Fielding, 2005 ). To the far left of the continuum, young people involved in research are referred to as “active respondents” and their data informs teacher practice. To the middle of the continuum sit “students as co-researchers” who work with teachers to explore an issue which has been identified by that teacher. Finally to the right, sit “students as researchers” who conduct their own research with support from teachers. Moving from left to right of the continuum shows a shift in power dynamics between young people and adults where a partnership develops. Young people are therefore recognized as equal to adults in terms of what they can bring to the project from their own unique perspective, that of being a young person now.

The studies.

In this paper, I advocate for the active involvement of young people in the research process in order to enhance bullying knowledge. Traditional quantitative studies have a tendency to homogenize young people by suggesting similarity in thinking about what constitutes bullying. However, qualitative studies have demonstrated that regardless of variables, young people understand bullying in different ways so there is a need for further research that starts from these perspectives and focusses on issues that young people deem important. Consequently, participatory research allows for the stories of the collective to emerge without losing the stories of the individual, a task not enabled through quantitative approaches.

What Is Bullying?

Researching school bullying has been problematic and is partly related to the difficulty in defining it ( Espelage, 2018 ). Broadly speaking, bullying is recognized as aggressive, repeated, intentional behavior involving an imbalance of power aimed toward an individual or group of individuals who cannot easily defend themselves ( Vaillancourt et al., 2008 ). In more recent times, “traditional” bullying behaviors have been extended to include cyber-bullying, involving the use of the internet and mobile-phones ( Espelage, 2018 ). Disagreements have been noted in the literature about how bullying is defined by researchers linked to subject discipline and culture. Some researchers for example, disagree about the inclusion or not of repetition in definitions ( Griffin and Gross, 2004 ) and these disagreements have had an impact on interpreting findings and prevalence rates. However, evidence further suggests that young people also view bullying in different ways ( Guerin and Hennessy, 2002 ; Cuadrado-Gordillo, 2012 ; Eriksen, 2018 ). Vaillancourt et al. (2008) explored differences between researchers and young people’s definitions of bullying, and found that children’s definitions were usually spontaneous, and did not always encompass the elements of repetition, power imbalance and intent. They concluded, that children need to be provided with a bullying definition so similarities and comparisons can be drawn. In contrast, Huang and Cornell (2015) found no evidence that the inclusion of a definition effected prevalence rates. Their findings, they suggest, indicate that young people use their own perceptions of bullying when answering self-report questionnaires and they are not influenced by an imposed definition.

Nevertheless, differences in children and young people’s bullying definitions are evident in the research literature and have been explained by recourse to age and stage of development ( Smith et al., 2002 ) and their assumed lack of understanding about what constitutes bullying ( Boulton and Flemington, 1996 ). Naylor et al. (2001) for example, found that younger children think similarly in their definitions of bullying, while Smith et al. (2002) found that 8 year olds did not distinguish as clearly between different forms of behavioral aggression as 14 year olds. Methodological limitations associated with understanding bullying have been identified by Forsberg et al. (2018) and Maunder and Crafter (2018) . These authors postulate that quantitative approaches, although providing crucial insights in understanding bullying, are reliant on pre-defined variables, which can shield some of the complexities that qualitative designs can unravel, as individual experiences of bullying are brought to the fore. Indeed, La Fontaine (1991) suggests that unlike standard self-report questionnaires and other quantitative methods used to collect bullying data, analyzing qualitative data such as those collected from a helpline, enables the voice of young people to be heard and consequently empowers adults to understand bullying on their terms rather than relying solely on interpretations and perceptions of adults. Moore and Maclean (2012) collected survey, as well as interview and focus group data, on victimization occurring on the journey to and from school. They found that what young people determined as victimization varied and was influenced by a multifaceted array of circumstances, some of which adults were unaware of. Context for example, played an important role where certain behaviors in one situation could be regarded as victimization while in another they were not. Specific behaviors including ignoring an individual was particularly hurtful and supporting a friend who was the subject of victimization could lead to their own victimization.

Lee (2006) suggests that some bullying research does not reflect individual experiences, and are thus difficult for participants to relate to. Canty et al. (2016) reiterates this and suggests that when researchers provide young people with bullying definitions in which to position their own experiences, this can mask some of the complexities that the research intends to uncover. Such approaches result in an oversight into the socially constructed and individual experiences of bullying ( Eriksen, 2018 ). Griffin and Gross (2004) further argue that when researchers use vague or ambiguous definitions an “overclassification of children as bullies or victims” (p. 381) ensues. Consequently, quantitative research does not consider children as reliable in interpreting their own lived experiences and therefore some of the interactions they consider as bullying, that do not fit within the conventional definitions, are concealed. This approach favors the adult definition of bullying regarding it as “more reliable” than the definitions of children and young people Canty et al. (2016) . The perceived “seriousness” of bullying has also been explored. Overall, young people and adults are more likely to consider direct bullying (face-to-face actions including hitting, threatening and calling names) as “more serious” than indirect bullying (rumor spreading, social exclusion, forcing others to do something they do not want to do) ( Maunder et al., 2010 ; Skrzypiec et al., 2011 ). This perception of “seriousness,” alongside ambiguous definitions of bullying, has further implications for reporting it. Despite the advice given to young people to report incidents of school bullying ( Moore and Maclean, 2012 ), the literature suggests that many are reluctant to do so ( deLara, 2012 ; Moore and Maclean, 2012 ).

Several factors have been highlighted as to why young people are reluctant to report bullying ( Black et al., 2010 ). deLara (2012) , found apprehension in reporting bullying to teachers due to the fear that they will either not do enough or too much and inadvertently make the situation worse, or fear that teachers will not believe young people. Research also shows that young people are reluctant to tell their parents about bullying due to perceived over-reaction and fear that the bullying will be reported to their school ( deLara, 2012 ; Moore and Maclean, 2012 ). Oliver and Candappa (2007) suggest that young people are more likely to confide in their friends than adults (see also Moore and Maclean, 2012 ; Allen, 2014 ). However, if young people believe they are being bullied, but are unable to recognize their experiences within a predefined definition of bullying, this is likely to impact on their ability to report it.

Research from psychology, sociology, education and other disciplines, utilizing both quantitative and qualitative approaches, have enabled the generation of bullying knowledge to date. However, in order to understand why bullying happens and how it is influenced by wider social constructs there is a need for further qualitative studies, which hear directly from children and young people themselves. The next section of this paper discusses the theoretical underpinnings of this paper, which recognizes that young people are active agents in generating new bullying knowledge alongside adults.

Theoretical Underpinnings – Hearing From Children and Young People

The sociology of childhood ( James, 2007 ; Tisdall and Punch, 2012 ) and children’s rights agenda more broadly ( United Nations Convention on the Rights of the Child, 1989 ) have offered new understandings and methods for research which recognize children and young people as active agents and experts on their own lives. From this perspective, research is conducted with rather than on children and young people ( Kellett, 2010 ).

Participatory methodologies have proven particularly useful for involving young people in research as co-researchers (see for example O’Brien and Moules, 2007 ; Stoudt, 2009 ; Kellett, 2010 ; Spears et al., 2016 ). This process of enquiry actively involves those normally being studied in research activities. Previously, “traditional” researchers devalued the experiences of research participants arguing that due to their distance from them, they themselves are better equipped to interpret these experiences ( Beresford, 2006 ). However, Beresford (2006) suggests that the shorter the distance between direct experience and interpretation, the less distorted and inaccurate the resulting knowledge is likely to be. Jones (2004) further advocates that when young people’s voices are absent from research about them the research is incomplete. Certainly Spears et al. (2016) , adopted this approach in their study with the Young and Well Cooperative Research Centre (CRC) in Australia. Young people played an active role within a multidisciplinary team alongside researchers, practitioners and policymakers to co-create and co-evaluate the learning from four marketing campaigns for youth wellbeing through participatory research. Through this methodological approach, findings show that young people were able to reconceptualize mental health and wellbeing from their own perspectives as well as share their lived experiences with others ( Spears et al., 2016 ). Bland and Atweh (2007) , Ozer and Wright (2012) , highlight the benefits afforded to young people through this process, including participating in dialog with decision-makers and bringing aspects of teaching and learning to their attention.

Against this background, data presented for this paper represents findings from four studies underpinned by the ethos that bullying is socially constructed and is best understood by exploring the context to which it occurs ( Schott and Sondergaard, 2014 ; Eriksen, 2018 ). This socially constructed view focusses on the evolving positions within young people’s groups, and argues that within a bullying situation sometimes a young person is the bully, sometimes the victim and sometimes the bystander/witness, which contrasts the traditional view of bullying ( Schott and Sondergaard, 2014 ). The focus therefore is on group relationships and dynamics. For that reason, Horton (2011) proposes that if bullying is an extensive problem including many young people, then focusing entirely on personality traits will not generate new bullying knowledge and will be problematic in terms of interventions. It is important to acknowledge that this change in focus and view of bullying and how it is manifested in groups, does not negate the individual experiences of bullying rather the focus shifts to the process of being accepted, or not, by the group ( Schott and Sondergaard, 2014 ).

The Studies

This section provides a broad overview of the four included studies underpinned by participatory methodologies. Table 1 presents the details of each study. Young people were involved in the research process as respondents, co-researchers and commissioners of research, along a continuum as identified by Bragg and Fielding (2005) . This ranged from “active respondents” to the left of the continuum, “students as co-researchers” in the middle and “students as researchers” to the right of the continuum. Young people were therefore recognized as equal to adults in terms of what they can bring to the project from their own unique perspectives ( Bradbury-Jones et al., 2018 ).

A key finding from study one ( O’Brien, 2009 ) was the lack of voice afforded to young people through the research process and can be seen to reflect the far left of Bragg and Fielding (2005) continuum, as young people were not directly involved as “active respondents” but their views were included in secondary data analysis and informed the studies that followed. For example, the quantitative studies used an agreed academic definition of bullying which may or may not have influenced how young participants defined bullying within the studies. On the other hand, the qualitative study involved a group of students in deciding which questions to ask of the research participants and in interpreting the findings.

In contrast, study two ( O’Brien and Moules, 2010 ) was commissioned and led by a group of young people called PEAR (Public health, Education, Awareness, Researchers), who were established to advise on public health research in England. PEAR members were based in two large English cities and comprised 20 young people aged between 13 and 20 years. The premise of the study was that PEAR members wanted to commission research into cyber bullying and the effects this has on mental health from the perspectives of young people rather than adult perspectives. This project was innovative as young people commissioned the research and participated as researchers ( Davey, 2011 ) and can be seen to reflect the middle “students as co-researchers” as well as moving toward to right “students as researchers” of Bragg and Fielding (2005) continuum. Although the young people did not carry out the day-to-day work on the project, they were responsible for leading and shaping it. More importantly, the research topic and focus were decided with young people and adults together.

Study three ( O’Brien, 2016 ) involved five self-selecting students from an independent day and boarding school who worked with me to answer this question: What do young people in this independent day and boarding school view as the core issue of bullying in the school and how do they want to address this? These students called themselves R4U (Research for You) with the slogan researching for life without fear . Three cycles of Participatory Action Research (PAR) ensued, where decision making about direction of the research, including methods, analysis and dissemination of findings were made by the research team. As current students of the school, R4U had a unique “insider knowledge” that complemented my position as the “academic researcher.” By working together to generate understanding about bullying at the school, the findings thus reflected this diversity in knowledge. As the project evolved so too did the involvement of the young researchers and my knowledge as the “outsider” (see O’Brien et al., 2018a for further details). Similar to study two, this project is situated between the middle: “students as co-researchers” and the right: “students as researchers” of Bragg and Fielding (2005) continuum.

Study four ( O’Brien, 2017 ) was small-scale and involved interviewing four young people who were receiving support from a charity providing therapeutic and educational support to young people who self-exclude from school due to anxiety, as a result of bullying. Self-exclusion, for the purposes of this study, means that a young person has made a decision not to go to school. It is different from “being excluded” or “truanting” because these young people do not feel safe at school and are therefore too anxious to attend. Little is known about the experiences of young people who self-exclude due to bullying and this study helped to unravel some of these issues. This study reflects the left of Bragg and Fielding (2005) continuum where the young people were involved as “active respondents” in informing adult understanding of the issue.

A variety of research methods were used across the four studies including questionnaires, interviews and focus groups (see Table 1 for more details). In studies two and three, young researchers were fundamental in deciding the types of questions to be asked, where they were asked and who we asked. In study three the young researchers conducted their own peer-led interviews. The diversity of methods used across the studies are a strength for this paper. An over-reliance on one method is not portrayed and the methods used reflected the requirements of the individual studies.

Informed Consent

Voluntary positive agreement to participate in research is referred to as “consent” while “assent,” refers to a person’s compliance to participate ( Coyne, 2010 ). The difference in these terms are normally used to distinguish the “legal competency of children over and under 16 years in relation to research.” ( Coyne, 2010 , 228). In England, children have a legal right to consent so therefore assent is non-applicable ( Coyne, 2010 ). However, there are still tensions surrounding the ability of children and young people under the age of 18 years to consent in research which are related to their vulnerability, age and stage of development ( Lambert and Glacken, 2011 ). The research in the three empirical studies (two, three and four) started from the premise that all young participants were competent to consent to participate and took the approach of Coyne (2010) who argues that parental/carer consent is not always necessary in social research. University Research Ethics Committees (RECs) are nonetheless usually unfamiliar with the theoretical underpinnings that children are viewed as social actors and generally able to consent for themselves ( Lambert and Glacken, 2011 ; Fox, 2013 ; Parsons et al., 2015 ).

In order to ensure the young people in these reported studies were fully informed of the intentions of each project and to adhere to ethical principles, age appropriate participant information sheets were provided to all participants detailing each study’s requirements. Young people were then asked to provide their own consent by signing a consent form, any questions they had about the studies were discussed. Information sheets were made available to parents in studies three and four. In study two, the parents of young people participating in the focus groups were informed of the study through the organizations used to recruit the young people. My full contact details were provided on these sheets so parents/carers could address any queries they had about the project if they wished. When young people participated in the online questionnaire (study two) we did not know who they were so could not provide separate information to parents. Consequently, all participants were given the opportunity to participate in the research without the consent of their parents/carers unless they were deemed incompetent to consent. In this case the onus was on the adult (parent or carer for example) to prove incompetency ( Alderson, 2007 ). Favorable ethical approval, including approval for the above consent procedures, was granted by the Faculty Research Ethics Committee at Anglia Ruskin University.

In the next section I provide a synthesis of the findings across the four studies before discussing how participatory research with young people can offer new understandings of bullying and its impacts on young people.

Although each study was designed to answer specific bullying research questions, the following key themes cut across all four studies 1 :

• • Impact of bullying on victim
• • Reporting bullying

Bullying Definitions

Young people had various understandings about what they considered bullying to be. Overall, participants agreed that aggressive direct behaviors, mainly focusing on physical aggression, constituted bullying:

“…if someone is physically hurt then that is bullying straight away.” (Female, study 3).

“I think [cyber-bullying is] not as bad because with verbal or physical, you are more likely to come in contact with your attacker regularly, and that can be disturbing. However, with cyber-bullying it is virtual so you can find ways to avoid the person.” (Female, study 2).

Name-calling was an ambiguous concept, young people generally believed that in isolation name-calling might not be bullying behavior or it could be interpreted as “joking” or “banter”:

“I never really see any, a bit of name calling and taking the mick but nothing ever serious.” (Male, study 3).

The concept of “banter” or “joking” was explored in study three as a result of the participatory design. Young people suggested “banter” involves:

“…a personal joke or group banter has no intention to harm another, it is merely playful jokes.” (Female, study 3).

However, underpinning this understanding of “banter” was the importance of intentionality:

“Banter saying things bad as a joke and everyone knows it is a joke.” (Male, study 3).

“Banter” was thus contentious when perception and reception were ambiguous. In some cases, “banter” was considered “normal behavior”:

“…we’ve just been joking about, but it’s never been anything harsh it’s just been like having a joke…” (Male, study 3).

The same view was evident in relation to cyber-bullying. Some participants were rather dismissive of this approach suggesting that it did not exist:

“I don’t really think it exists. If you’re being cyber-“bullied” then there is something wrong with you- it is insanely easy to avoid, by blocking people and so on. Perhaps it consists of people insulting you online?” (Male, study 2).

When young people considered additional factors added to name calling such as the type of name-calling, or aspects of repetition or intention, then a different view was apparent.

“…but it has to be constant it can’t be a single time because that always happens.” (Male, study 3).

Likewise with words used on social media, young people considered intentionality in their consideration of whether particular behaviors were bullying, highlighting important nuances in how bullying is conceptualized:

“Some people they don’t want to sound cruel but because maybe if you don’t put a smiley face on it, it might seem cruel when sometimes you don’t mean it.” (Female, study 2).

Study one also found that young people were more likely to discuss sexist or racist bullying in interviews or focus groups but this information was scarce in the questionnaire data. This is possibly as a result of how the questions were framed and the researchers’ perspectives informing the questions.

Evident across the four studies was the understanding young people had about the effects of continuous name-calling on victims:

“…you can take one comment, you can just like almost brush it off, but if you keep on being bullied and bullied and bullied then you might kind of think, hang on a minute, they’ve taken it a step too far, like it’s actually become more personal, whereas just like a cheeky comment between friends it’s become something that’s more serious and more personal and more annoying or hurtful to someone.” (Female, study 3).

“Cyber-bullying is basically still verbal bullying and is definitely psychological bullying. Any bullying is psychological though, really. And any bullying is going to be harmful.” (Female, study 2).

Aspects of indirect bullying (social exclusion) were features of studies one and three. For the most part, the research reviewed in study one found that as young people got older they were less likely to consider characteristics of social exclusion in their definitions of bullying. In study three, when discussing the school’s anti-bullying policy, study participants raised questions about “ isolating a student from a friendship group .” Some contested this statement as a form of bullying:

“…. there is avoiding, as in, not actively playing a role in trying to be friends which I don’t really see as bullying I see this as just not getting someone to join your friendship group. Whereas if you were actually leaving him out and rejecting him if he tries to be friends then I think I would see that as malicious and bullying.” (Male, study 3).

“Isolating a student from a friendship group – I believe there are various reasons for which a student can be isolated from a group – including by choice.” (Female, study 3).

Cyber-bullying was explored in detail in study two but less so in the other three studies. Most study two participants considered that cyber-bullying was just as harmful, or in some cases worse than, ‘traditional’ bullying due to the use of similar forms of “harassment,” “antagonizing,” “tormenting,” and ‘threatening’ through online platforms. Some young people believed that the physical distance between the victim and the bully is an important aspect of cyber-bullying:

“I think it’s worse because people find it easier to abuse someone when not face to face.” (Male, study 2).

“I think it could be worse, because lots of other people can get involved, whereas when it’s physical bullying it’s normally just between one or two or a smaller group, things could escalate too because especially Facebook, they’ve got potential to escalate.” (Female, study 2).

Other participants in study two spoke about bullying at school which transfers to an online platform highlighting no “escape” for some. In addition, it was made clearer that some young people considered distancing in relation to bullying and how this influences perceptions of severity:

“…when there’s an argument it can continue when you’re not at school or whatever and they can continue it over Facebook and everyone can see it then other people get involved.” (Female, study 2).

“I was cyber-bullied on Facebook, because someone put several hurtful comments in response to my status updates and profile pictures. This actually was extended into school by the bully…” (Male, study 2).

Impact of Bullying on Victim

Although bullying behaviors were a primary consideration of young people’s understanding of bullying, many considered the consequences associated with bullying and in particular, the impact on mental health. In these examples, the specifics of the bullying event were irrelevant to young people and the focus was on how the behavior was received by the recipient.

In study two, young people divulged how cyber-bullying had adversely affected their ability to go to school and to socialize outside school. Indeed some young people reported the affects it had on their confidence and self-esteem:

“I developed anorexia nervosa. Although not the single cause of my illness, bullying greatly contributed to my low self-esteem which led to becoming ill.” (Female, study 2).

“It hurts people’s feelings and can even lead to committing suicide….” (Female, study 2).

Across the studies, young people who had been bullied themselves shared their individual experiences:

“….you feel insecure and it just builds up and builds up and then in the end you have no self-confidence.” (Female, study 2).

“…it was an everyday thing I just couldn’t take it and it was causing me a lot of anxiety.” (Male, study 4).

“I am different to everyone in my class …. I couldn’t take it no more I was upset all the time and it made me feel anxious and I wasn’t sleeping but spent all my time in bed being sad and unhappy.” (Male, study 4).

Young people who had not experienced bullying themselves agreed that the impact it had on a person was a large determiner of whether bullying had happened:

“When your self-confidence is severely affected and you become shy. Also when you start believing what the bullies are saying about you and start to doubt yourself.” (Female, study 3).

“…it makes the victim feel bad about themselves which mostly leads to depression and sadness.” (Male, study 2).

Further evidence around the impact of bullying was apparent in the data in terms of how relational aspects can affect perceived severity. In the case of cyber-bullying, young people suggested a sense of detachment because the bullying takes place online. Consequently, as the relational element is removed bullying becomes easier to execute:

“…because people don’t have to face them over a computer so it’s so much easier. It’s so much quicker as well cos on something like Facebook it’s not just you, you can get everyone on Facebook to help you bully that person.” (Female, study 2).

“Due to technology being cheaper, it is easier for young people to bully people in this way because they don’t believe they can be tracked.” (Male, study 2).

“The effects are the same and often the bullying can be worse as the perpetrator is unknown or can disguise their identity. Away from the eyes of teachers etc., more can be done without anyone knowing.” (Female, study 2).

Relational aspects of bullying were further highlighted with regards to how “banter” was understood, particularly with in-group bullying and how the same example can either be seen as “banter” or bullying depending on the nature of the relationship:

“…we’ve just been joking about, but it’s never been anything harsh it’s just been like having a joke. well, I haven’t done it but I’ve been in a crowd where people do it, so I don’t want to get involved just in case it started an argument.” (Female, study 3).

“But it also depends…who your groups with, for example, if I spoke to my friends from [School]… I wouldn’t like use taboo language with them because to them it may seem inappropriate and probably a bit shocked, but if I was with my friends outside of school we use taboo language, we’ll be ourselves and we’ll be comfortable with it, and if a stranger walked past and heard us obviously they’d be thinking that we’re being bullied ourselves.” (Female, study 3).

Furthermore, how individuals are perceived by others tended to influence whether they were believed or not. In study four for example, participants suggested that who the bullies were within the school might have impacted how complaints were acted upon by school officials:

“When I went to the school about it, the students said I had attacked them – all eight of them! I just realized that no one believes me….” (Female, study 4).

While in study three, a characteristic of bullying was the influence the aggressor has over the victim:

“When the victim starts to feel in danger or start to fear the other person. Consequently he or she tries to avoid the bad guy (or girl!)” (Male, study 3).

These relational and contextual issues also influenced a young person’s ability to report bullying.

Reporting Bullying

Young people were more likely to report bullying when they considered it was ‘serious’ enough. Just under half of participants in study two sought emotional/practical support if they worried about, or were affected by cyber-bullying, with most talking to their parents. In study three, young people were less likely to seek support but when they did, most went to their teachers. In study four, all participants reported bullying in school where they did not feel supported.

Fear of making the bullying worse was captured across the studies as a reason for not reporting it:

“I’m scared that if I tell then the bullying will still go on and they will do more.” (Female, study 3).

“The bully might bully you if he finds out.” (Male, study 3).

Being able to deal with the incident themselves was also a reason for non-reporting:

“…it’s embarrassing and not necessary, my friends help me through it, adults never seem to understand.” (Female, study 2).

“I don’t tend to talk to anyone about it, I just keep it to myself and obviously that’s the worst thing you should ever do, you should never keep it to yourself, because I regret keeping it to myself to be honest….” (Female, study 3).

“…but I think I’d deal with it myself ‘cos. I was quite insecure but now I’m quite secure with myself, so I’ll sort it out myself. I think it’s just over time I’ve just sort of hardened to it.” (Male, study 3).

Most young people seeking support for bullying said they spoke to an adult but the helpfulness of this support varied. This finding is important for understanding relationships between young people and adults. Those who felt supported by their teachers for example, suggested that they took the time to listen and understood what they were telling them. They also reassured young people who in turn believed that the adult they confided in would know what to do:

“So I think the best teacher to talk to is [Miss A] and even though people are scared of her I would recommend it, because she’s a good listener and she can sense when you don’t want to talk about something, whereas the other teachers force it out of you.” (Female, study 3).

“My school has had assemblies about cyber-bullying and ways you can stop it or you can report it anonymously…. you can write your name or you can’t, it’s all up to YOU.” (Male, study 2).

Others however had a negative experience of reporting bullying and a number of reasons were provided as to why. Firstly, young people stated that adults did not believe them which made the bullying worse on some level:

“I went to the teachers a couple of times but, no, I don’t think they could do anything. I did sort of go three times and it still kept on going, so I just had to sort of deal with it and I sort of took it on the cheek….” (Male, study 3).

Secondly, young people suggested that adults did not always listen to their concerns, or in some cases did not take their concerns seriously enough:

“…I had had a really bad day with the girls so I came out and I explained all this to my head of year and how it was affecting me but instead of supporting me he put me straight into isolation.” (Male, study 4).

“I could understand them thinking I maybe got the wrong end of the stick with one incident but this was 18 months of me constantly reporting different incidents.” (Female, study 4).

“If cyber-bullying is brought to our school’s attention, usually, they expect printed proof of the situation and will take it into their own hand depending on its seriousness. However this is usually a couple of detentions. And it’s just not enough.” (Female, study 2).

Finally, some young people suggested that teachers did not always know what to do when bullying concerns were raised and consequently punished those making the complaint:

“I think I would have offered support instead of punishment to someone who was suffering with anxiety. I wouldn’t have seen anxiety as bad behavior I think that’s quite ignorant but they saw it as bad behavior.” (Male, study 4).

It is worth reiterating, that the majority of young people across the studies did not report bullying to anybody , which further underscores the contextual issues underpinning bullying and its role in enabling or disabling bullying behaviors. Some considered it was “pointless” reporting the bullying and others feared the situation would be made worse if they did:

“My school hide and say that bullying doesn’t go on cos they don’t wanna look bad for Ofsted.” (Male, study 2).

“My school is oblivious to anything that happens, many things against school rules happen beneath their eyes but they either refuse to acknowledge it or are just not paying attention so we must suffer.” (Female, study 2).

“That’s why I find that when you get bullied you’re scared of telling because either, in most cases the teacher will – oh yeah, yeah, don’t worry, we’ll sort it out and then they don’t tend to, and then they get bullied more for it.” (Female, study 3).

Young people were concerned that reporting bullying would have a negative impact on their friendship groups. Some were anxious about disrupting the status quo within:

“I think everyone would talk about me behind my back and say I was mean and everyone would hate me.” (Female, study 3).

Others expressed concern about the potential vulnerability they were likely to experience if they raised concerns of bullying:

“I was worried it might affect my other friendships.”(Boy, study 2).

“I’m scared that if I tell, then the bullying will still go on and they will do more.” (Female, study 3).

“….because they might tell off the bullies and then the bullies will like get back at you.” (Female, study 3).

These findings underscore the importance of contextual and relational factors in understanding bullying from the perspectives of young people and how these factors influence a young person’s ability or willingness to report bullying.

Finally one young person who had self-excluded from school due to severe bullying suggested that schools:

“…need to be looking out for their students’ mental wellbeing – not only be there to teach them but to support and mentor them. Keep them safe really… I missed out on about three years of socializing outside of school because I just couldn’t do it. I think it’s important that students are encouraged to stand up for each other.” (Female, study 4).

The studies presented in this paper illustrate the multitude of perceptions underpinning young people’s understandings of what constitutes bullying, both in terms of the behavior and also the impact that this behavior has on an individual. In turn, the ambiguity of what constitutes bullying had an impact on a young person’s ability to seek support. Discrepancies in bullying perceptions within and between young people’s groups are shown, highlighting the fluid and changing roles that occur within a bullying situation. Findings from quantitative studies have demonstrated the differing perceptions of bullying by adults and young people (see for example Smith et al., 2002 ; Vaillancourt et al., 2008 ; Maunder et al., 2010 ; Cuadrado-Gordillo, 2012 ). However, by combining findings from participatory research, new understandings of the relational and contextual factors important to young people come to the fore.

Young people participating in these four studies had unique knowledge and experiences of bullying and the social interactions of other young people in their schools and wider friendship groups. The underpinning participatory design enabled me to work alongside young people to analyze and understand their unique perspectives of bullying in more detail. The research teams were therefore able to construct meaning together, based not entirely on our own assumptions and ideologies, but including the viewpoint of the wider research participant group ( Thomson and Gunter, 2008 ). Together, through the process of co-constructing bullying knowledge, we were able to build on what is already known in this field and contribute to the view that bullying is socially constructed through the experiences of young people and the groups they occupy ( Schott and Sondergaard, 2014 ).

With regards to understanding what bullying is, the findings from these studies corroborate those of the wider literature from both paradigms of inquiry (for example Naylor et al., 2001 ; Canty et al., 2016 ); that being the discrepancies in definitions between adults and young people and also between young people themselves. Yet, findings here suggest that young people’s bullying definitions are contextually and relationally contingent. With the exception of physical bullying, young people did not differentiate between direct or indirect behaviors, instead they tended to agree that other contextual and relational factors played a role in deciding if particular behaviors were bullying (or not). The participatory research design enabled reflection and further investigation of the ideas that were particularly important to young people such as repetition and intentionality. Repetition was generally seen as being indicative of bullying being “serious,” and therefore more likely to be reported, and without repetition, a level of normality was perceived. This finding contradicts some work on bullying definitions, Cuadrado-Gordillo (2012) for example found that regardless of the role played by young people in a bullying episode (victim, aggressor or witness), the criteria of ‘repetition’ was not important in how they defined bullying.

Relational factors underpinning young people’s perception of bullying and indeed it’s “seriousness” were further reflected in their willingness or otherwise to report it. Fear of disrupting the status quo of the wider friendship group, potentially leading to their own exclusion from the group, was raised as a concern by young people. Some were concerned their friends would not support them if they reported bullying, while others feared further retaliation as a result. Friendship groups have been identified as a source of support for those who have experienced bullying and as a protective factor against further bullying ( Allen, 2014 ). Although participants did not suggest their friendship groups are unsupportive it is possible that group dynamics underscore seeking (or not) support for bullying. Other literature has described such practices as evidence of a power imbalance ( Olweus, 1995 ; Cuadrado-Gordillo, 2012 ) but young people in these studies did not describe these unequal relationships in this way and instead focused on the outcomes and impacts of bullying. Indeed Cuadrado-Gordillo (2012) also found that young people in their quantitative study did not consider “power imbalance” in their understanding of bullying and were more likely to consider intention. This paper, however, underscores the relational aspects of definitions of bullying and, how the dynamics of young people’s friendships can shift what is understood as bullying or not. Without such nuances, some behaviors may be overlooked as bullying, whereas other more obvious behaviors draw further attention. This paper also shows that contextual issues such as support structures can shift how young people see bullying. Contextual factors were evident across the four studies through the recognition of bullying being enabled or disabled by institutional factors, including a school’s ability to respond appropriately to bullying concerns. Young people suggested that schools could be influenced by bullies, perceiving them as non-threatening and consequently not dealing appropriately with the situation. Indeed some young people reported that their schools placed the onus on them as victims to change, consequently placing the “blame” on victims instead. These findings raise questions about who young people feel able to confide in about bullying as well as issues around training and teacher preparedness to deal with bullying in schools. Evidenced in these four studies, is that young people feel somewhat disconnected from adults when they have bullying concerns. Those who did report bullying, identified particular individuals they trusted and knew would support them. Novick and Isaacs (2010) identified teachers who young people felt comfortable in approaching to report bullying and described them as “most active, engaged and responsive.” (p. 291). The bullying literature suggests that as young people get older they are more likely to confide in friends than adults ( Moore and Maclean, 2012 ; Allen, 2014 ). However, findings from this paper indicate that although fewer young people reported bullying, those who did confided in an adult. Young people have identified that a variety of supports are required to tackle bullying and that adults need to listen and work with them so nuanced bullying behaviors are not recognized as “normal” behaviors. Within the data presented in this paper, “banter” was portrayed as “normal” behavior. Young people did not specify what behaviors they regarded as “banter,” but suggested that when banter is repeated and intentional the lines are blurred about what is bullying and what is banter.

Exploring bullying nuances in this paper, was enhanced by the involvement of young people in the research process who had a unique “insider” perspective about what it is like to be a young person now and how bullying is currently affecting young people. In studies one and four, young people were “active respondents” ( Bragg and Fielding, 2005 ) and provided adults with their own unique perspectives on bullying. It could be argued that study one did not involve the participation of young people. However, this study informed the basis of the subsequent studies due to the discrepancies noted in the literature about how bullying is understood between adults and young people, as well as the lack of young people’s voice and opportunity to participate in the reviewed research. Accordingly, young people’s data as “active respondents” informed adult understanding and led to future work involving more active research engagement from other young people. Participation in study four provided an opportunity for young people to contribute to future participatory research based on lived experiences as well as informing policy makers of the effects bullying has on the lives of young people ( O’Brien, 2017 ). In studies two and three, young people were involved further along Bragg and Fielding (2005) continuum as “co-researchers” and “students as researchers” with these roles shifting and moving dependent on the context of the project at the time ( O’Brien et al., 2018a ). These young researchers brought unique knowledge to the projects ( Bradbury-Jones et al., 2018 ) that could not be accessed elsewhere. Perspectives offered by the young researchers supported adults in understanding more about traditional and cyber-bullying from their perspectives. Furthermore, this knowledge can be added to other, quantitative studies to further understand why bullying happens alongside bullying prevalence, risk and protective factors, and negative outcomes.

Findings from the four studies offer an alternative perspective to how bullying is understood by young people. Complexities in defining bullying have been further uncovered as understanding is informed by individual factors, as well as wider social and relational contexts ( Horton, 2011 ; Schott and Sondergaard, 2014 ). This has implications for the type of support young people require. This paper highlights how definitions of bullying shift in response to relational and contextual aspects deemed important to young people. Because of this, further nuances were uncovered through the research process itself as the respective studies showed discrepancies in bullying perceptions within and between young people’s groups.

These understandings can act as a starting point for young people and adults to collaborate in research which seeks to understand bullying and the context to which it occurs. Furthermore, such collaborations enable adults to theorize and understand the complexities associated with bullying from the perspective of those at the center. There is a need for additional participatory research projects involving such collaborations where adults and young people can learn from each other as well as combining findings from different methodologies to enable a more comprehensive picture of the issues for young people to emerge. Further research is needed to unravel the complexities of bullying among and between young people, specifically in relation to the contextual and relational factors underscoring perceptions of bullying.

Data Availability

Ethics statement.

Ethical approval was granted for all four studies from the Faculty of Health, Education, Medicine and Social Care at the Anglia Ruskin University. The research was conducted on the premise of Gillick competency meaning that young people (in these studies over the age of 12 years) could consent for themselves to participate. Parents/carers were aware the study was happening and received information sheets explaining the process.

Author Contributions

The author confirms being the sole contributor of this work and has approved it for publication.

Conflict of Interest Statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

I would like to thank Dr. Grace Spencer, Ruskin Fellow at the Anglia Ruskin University for providing the critical read of this manuscript and offering constructive feedback. I would also like to thank the two independent reviewers for their feedback on the drafts of this manuscript.

Funding. These four studies were conducted at the Anglia Ruskin University. Study one was part of a wider masters degree funded by the Anglia Ruskin University, Study two was funded by a group of young people convened by the National Children’s Bureau with funding from the Wellcome Trust (United Kingdom). Study three was a wider Doctoral study funded by the Anglia Ruskin University and Study four was also funded by the Anglia Ruskin University.

1 These findings focus on perceptions and data from the young people in the four studies. For a full discussion on adult perceptions please refer to the individual studies.

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