School bullying and mental health among adolescents: a narrative review

Introduction

In recent years, school bullying has become a growing concern among the public, including educators, scholars, and other relevant stakeholders. Defined as intentional, repeated, and harmful aggressive behaviors among peers, bullying has emerged as a severe public health problem for adolescents (1). Negative behaviors such as social isolation, aggression, malicious teasing, and verbal abuse inflict severe distress upon victims (2). A report by the United Nations highlights that approximately 2.46 billion children and youth experience school violence and bullying on an annual basis (3), therefore school bullying has evolved into a widespread global social concern (4,5).

School bullying not only presents social adaptation challenges but also significantly impacts adolescents’ physical and mental health. Adolescent mental health problems have become a major public health concern (6,7). Empirical evidence indicates that bullying not only results in physical harm but also has detrimental effects on psychological and cognitive-behavioral development (8,9). Victims may encounter anxiety, depression, substance abuse, and suicidal thoughts, thereby complicating their academic performance, personal life, peer interactions, and parent-child relationships, and potentially leading to extreme behaviors (10).

To facilitate the development of intervention aiming at reducing school bullying and its associated mental health consequences, there is a need to review the most recent research progress on school bullying and its negative effects on mental health among adolescents. This narrative review summarizes the conception and epidemiology of school bullying and its associations with mental health problems in adolescents. The goal is to identify the current knowledge gaps and provide insights for effective interventions for school bullying and improving the mental health of adolescents. We present this article in accordance with the Narrative Review reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2024-512/rc).

Methods

Three online databases (Web of Science, PubMed, and China National Knowledge Infrastructure) were searched for relevant studies from their inception to October 25, 2024. English- and Chinese-language studies concerning school bullying in adolescents and its relationship with mental health problems among adolescents were included. A total of 2,593 potential articles were retrieved, and ultimately, 59 eligible articles were included. Detailed literature search strategies are outlined in Table 1.

Results

Conception of school bullying

School bullying, first proposed by a Norwegian scholar, Olweus, is defined as deliberate, repeated aggressive behavior involving a certain degree of power inequality among participants, reflecting poor peer relationships (2). Its core characteristics include repetition, power imbalance, and a clear intention to harm. Other scholars, such as Smith and Thompson, define school bullying as a subset of aggressive behavior with intentional harm, either physical or psychological (11). In China, Zhang and colleagues defined school bullying as a special form of aggressive behavior characterized by power imbalance (12). Additionally, another research group, You and Tang, expand the definition of bullying to encompass various venues, noting its incidence in schools where harm is inflicted through unreasonable means and extending to teacher-student and teacher-teacher relationships (13).

Classification of school bullying

Bullying behaviors exhibit various forms. According to Lin, bullying can be divided into six types: relational, verbal, physical, gender-based, retaliatory, and cyberbullying (14). Relational bullying, often paired with verbal bullying, involves relationship manipulation, social exclusion, and rumor spreading. These forms, though physically harmless, can cause significant psychological damage early on. Physical bullying is easily identifiable and a major concern for educators. Gender-based bullying involves harmful sex-related actions. Retaliatory bullying arises when victims respond to prolonged bullying. Cyberbullying, unrestrained by limits, encompasses all forms and can cause greater, longer-lasting harm.

Olweus categorizes school bullying into five types: verbal bullying, physical bullying, relational bullying, sexual bullying, and cyberbullying. Among these forms, verbal bullying is the most frequent one (2). Verbal bullying includes name-calling, teasing, using offensive language, and verbal threats. Physical bullying encompasses actions like pushing, hitting, stealing, or damaging property to harm others. Relational bullying involves ostracizing peers, ignoring vulnerable classmates, and spreading negative rumors. Sexual bullying comprises behaviors like making sexual jokes, name-calling, spreading sexual rumors, sending sexually inappropriate photos or videos, and unwanted physical contact. Cyberbullying is conducted through various digital platforms like text messages, social media, apps, or online forums, often involving the sharing of harmful content and personal information to humiliate others.

Prevalence of school bullying

Adolescents are more likely to be victims of school bullying (“being bullied”) (15). Epidemiological surveys reveal that approximately 10–30% of adolescents worldwide are victims of school bullying (16). A cross-sectional study from 28 Western countries shows that around 41% of students are victims of school bullying (17). An international study involving 151,184 school-going students across 40 low- and middle-income countries found that 28.7% reported being bullied for at least one day, with the highest bullying victimization rate in the age group of 11–13 years (18). In China, a survey involving 3,675 primary and middle school students from seven provinces found that 25.4% of students have experienced bullying (19).

Factors associated with school bullying

Factors associated with school bullying are often categorized into individual, familial, school-related, and societal factors.

Individual factors

Emotional or mental health status is a significant correlate of being bullied in schools. Factors such as low self-esteem, sadness, despair, and excessive academic pressure increase adolescents’ susceptibility to becoming targets of bullying (20,21). Additionally, being a boy, belonging to sexual minority groups such as LGBTQ (lesbian, gay, bisexual, transgender, queer), and obesity are significant contributors to becoming victims of bullying among adolescents (22-26). Furthermore, adolescents with poor social skills, physical appearance, academic performance, or a solitary personality are more prone to being bullied (27).

Familial factors

Evidence indicates that parenting styles, along with the presence of warmth or violence within a family, significantly influence bullying behavior (28,29). Families characterized by positive interactions serve as a protective barrier against bullying, whereas dysfunctional family environments and emotional neglect heighten the risk of bullying behavior (30-32).

School-related factors

A nurturing school environment fosters a reduction in bullying (33). The norms established within classrooms and the peer pressure experienced by students also play crucial roles in predicting bullying behaviors (34). Schools that prioritize autonomous learning, social support, and stress management are less prone to bullying incidents (35).

Societal factors

Social media is increasingly used by adolescents (36). The widespread availability of violent content in social media can have a detrimental impact on impressionable young minds, potentially increasing the risk of bullying behavior in schools (37,38).

Negative impact of school bullying on the mental health

Numerous studies have demonstrated that school bullying significantly influences students’ mental health, and its repercussions extend beyond victims, encompassing all parties involved, including bullies and bystanders (39).

Victims of bullying bear the brunt of the most profound impacts, which have garnered considerable research attention. According to a review by Armitage, the impacts of school bullying are categorized into three types: educational consequences during childhood, health consequences during childhood and all consequences during adulthood (40). Short-term educational consequences pertain to education and academic performance. There is evidence that bullying is associated with various negative academic outcomes, including poor performance, reduced motivation, low self-esteem, educational aspirations, and exam anxiety (16,41-43). Short-term health consequences encompass internalized problems such as depression, panic, and low self-esteem, as well as externalized behavioral problems such as substance abuse, violence, antisocial behavior, and self-harm (44). Accumulating evidence has shown significant associations between bullying victims and a range of mental health problems, including paranoia, post-traumatic stress symptoms, suicidal ideation, suicide attempts, anxiety, and depression (45-49). Bullied adolescents are also more prone to anxiety disorders such as social phobia. Findings from a meta-analysis confirmed the causal relationships between being bullied and several mental health problems: drug use, anxiety, depression, self-harm, and suicidal ideation (4).

The negative impacts of school bullying on mental health are long-lasting and persist into adulthood, even after the bullying has ceased (50). Experiencing bullying during childhood has been linked to poorer health outcomes in adulthood, including substance use disorders, anxiety, depressive symptoms, and an increased risk of suicide (51,52). Furthermore, childhood bullying experiences have been associated with an increased risk of mental disorders during early adulthood, such as major depression, panic disorder, and generalized anxiety disorder (53). There is evidence that the detrimental effects of bullying on mental health can persist into older adulthood. For example, a study of retired elderly individuals revealed that, although the negative impact of bullying diminishes over time, those who were bullied during childhood still exhibit significantly more severe depressive symptoms and are significantly more likely to be dissatisfied with life compared to those without bullying experiences (54). Being bullied may even increase the risk of interpersonal violence when victims grow into adulthood (55-57). Additionally, other studies have found that bullying victims are at a higher risk of engaging in criminal behavior (58).

School bullying not only harms victims but also has a profound effect on all students involved. Bullying behaviors entail a series of negative consequences for bullies as well. For example, research has shown that past bullying behaviors increase the suicide tendency among bullies (59). An increased risk of emotional and behavioral problems, including post-traumatic stress disorder and attention-deficit/hyperactivity disorder, was also reported among bullies (60,61). The aggressive experiences and psychological changes of bullies may later manifest as externalized behaviors such as criminality. Evidence shows that bullies are more likely to develop antisocial personality disorder, and bullying experiences contribute to increased crime rates among bullies in adulthood (53,62).

The repercussions of school bullying extend far beyond the immediate victims and perpetrators, reaching into the lives of those who merely witness such acts. Bystanders can suffer from vicarious traumatization, indirectly experiencing distress due to observing bullying incidents (63). This exposure heightens their vulnerability to mental health challenges, including anxiety, depression, suicidal ideation, sleep disturbances, internalized struggles, and overall psychological distress (47,64-68). Intriguingly, research suggests that bystanders may experience even greater mental health detriments compared to direct participants in bullying scenarios (69). Furthermore, the cognitive and psychological development of bystanders is negatively impacted. Their capacity for healthy personality formation and maintaining sound mental well-being is hindered (70). The act of witnessing peer victimization also serves as a predictor for increased substance abuse among bystanders, highlighting the profound and multifaceted consequences of being an observer in a bullying environment (71).

In sum, the effects of school bullying are profound and enduring. The traumatic consequences do not easily fade but continue to impact the lives and well-being of victims in various ways throughout their lives. Addressing bullying necessitates a comprehensive strategy that takes into account the needs and experiences of all students within the school community.

Discussion

The widespread prevalence of school bullying remains one of the most significant challenges faced by contemporary adolescents globally. Numerous studies have examined the epidemiology of school bullying and its detrimental effects on the mental health of adolescents, given the large number of adolescents affected by bullying and the substantial disease burden caused by mental health issues within this population.

Scholars have proposed various interpretations and definitions of school bullying, which can be summarized as aggressive behavior involving two parties with unequal power dynamics, causing either psychological or physical harm to the victim. Based on this definition, school bullying can be broadly classified into five categories: physical, verbal, relational, sexual and cyber bullying. This classification aligns closely by Chinese researchers Lin and colleagues in their review (72).

School bullying often links to numerous adverse consequences, severely impacting the mental health of adolescents. This harm affects not only those directly involved but also bystanders. In the short term, bullying can influence victims’ academic performance, cause exam anxiety, and is linked to subsequent depression, substance abuse, and self-harm. In the long term, its effects are profound and lasting, negatively affecting mental health development throughout a person’s life. For bullies, it increases suicidal ideation and aggressive behaviors and may lead to emotional disorders. For bystanders, witnessing bullying can cause vicarious trauma, increasing their risk of mental health issues.

In response to the health challenges of this widespread and far-reaching social problem, scholars have investigated the risk factors of school bullying from various perspectives. This paper categorizes the associated factors into four groups: individual, family, school, and society. Individual factors involve demographic factors such as sex, emotional or mental health status, and obesity; family factors include parenting styles and family dynamics; school climate and class norms can also influence bullying behavior; and societal factors, particularly the social media, have a significant impact on bullying. These factors may independently or synergistically explain bullying behavior. Regardless, they offer valuable insights for preventing and addressing school bullying.

Given the negative and profound impact of school bullying, effective prevention and intervention measures should be implemented. Researchers have developed several short- and long-term intervention strategies from psychological and educational perspectives, achieving promising results. Psychologically, group counseling, cooperative games, and fostering student friendships effectively alter attitudes and perceptions towards bullying, thereby reducing its incidence (73,74). Research further suggests that cognitive-behavioral and acceptance commitment therapies can diminish bullying and improve victims’ mental well-being (75,76). Educationally, strategies such as conducting moral education courses on school bullying, enhancing students’ awareness of moral and legal norms, and establishing strict management systems to regulate student behavior have been gradually proven effective by researchers (77,78). Collaboration between schools and families can also effectively address bullying (79,80). Simply, positive family dynamics notably boosts adolescents’ mental health and cuts down bullying (81,82). These initiatives provide guidance for schools and society on preventing, intervening in, and even eliminating bullying.

So far, limited research evidence is available on the effectiveness of preventing and addressing school bullying at the family and societal levels. Future intervention studies need to consider approaches developed from the perspectives of family dynamics and social policy changes related to social media. Studies show that addressing a complex social problem like school bullying requires not only enhanced daily prevention in schools but also the refinement of the legal disciplinary system. This involves diverse entities collaborating to establish scientific and reasonable bullying prevention measures (83). Legally, specific regulations on school bullying should be formulated with detailed criteria for severity and procedures for addressing incidents. This includes clarifying responsibilities and improving oversight mechanisms to ensure law-based prevention and intervention efforts (84). When prevention strategies fail, it is essential to help victims avoid repeated bullying and mitigate harm, necessitating combined efforts from families, schools, and society. In response to the complex and challenging situation, it is necessary to implement a “home-school collaboration” approach to effectively address school bullying. This approach incorporates establishing trust and communication, developing contextualized educational mechanisms, enhancing students’ practical skills, cultivating a professional education team, and constructing assessment and feedback mechanisms (85). Additionally, setting up help-seeking channels and psychological counseling departments to support victims is crucial (86). In summary, preventing and managing school bullying remains challenging, with much room for future examination.

Conclusions

This study primarily reviews the impact of school bullying on adolescent mental health, a topic that has not been systematically reviewed in previous literature. Building upon prior research (87), this review includes studies of Chinese adolescents, enhancing the diversity of the target population. Existing research indicates that school bullying is not a regional issue but a global public concern that poses severe threats to adolescents’ health worldwide and is associated with numerous adverse mental health consequences. However, due to the complexity of its causes, which involve multiple facets and levels and remain inconclusive, further studies are warranted. Although some preventive measures have been implemented to reduce bullying in schools, its prevalence remains high, indicating that more research is needed to develop more effective public health interventions. Ideally, we should aim to nip bullying in the bud, which would help decrease the burden of mental disorders in adolescents, but achieving this goal remains a formidable challenge.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2024-512/rc

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2024-512/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2024-512/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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