Published online Mar 22, 2017. doi: 10.5498/wjp.v7.i1.60
Peer-review started: September 14, 2016
First decision: October 21, 2016
Revised: December 4, 2016
Accepted: December 27, 2016
Article in press: December 28, 2016
Published online: March 22, 2017
To identify health and psychosocial problems associated with bullying victimization and conduct a meta-analysis summarizing the causal evidence.
A systematic review was conducted using PubMed, EMBASE, ERIC and PsycINFO electronic databases up to 28 February 2015. The study included published longitudinal and cross-sectional articles that examined health and psychosocial consequences of bullying victimization. All meta-analyses were based on quality-effects models. Evidence for causality was assessed using Bradford Hill criteria and the grading system developed by the World Cancer Research Fund.
Out of 317 articles assessed for eligibility, 165 satisfied the predetermined inclusion criteria for meta-analysis. Statistically significant associations were observed between bullying victimization and a wide range of adverse health and psychosocial problems. The evidence was strongest for causal associations between bullying victimization and mental health problems such as depression, anxiety, poor general health and suicidal ideation and behaviours. Probable causal associations existed between bullying victimization and tobacco and illicit drug use.
Strong evidence exists for a causal relationship between bullying victimization, mental health problems and substance use. Evidence also exists for associations between bullying victimization and other adverse health and psychosocial problems, however, there is insufficient evidence to conclude causality. The strong evidence that bullying victimization is causative of mental illness highlights the need for schools to implement effective interventions to address bullying behaviours.
Core tip: There is convincing evidence of a causal association between exposure to bullying victimization in children and adolescents and adverse health outcomes including anxiety, depression, poor mental health, poor general health, non-suicidal self-injury, suicidal ideation and suicide attempts. It is probable that bullying victimization also causes an increased risk of cigarette smoking and illicit drug use. This review highlights that bullying victimization is associated with a wide and diverse range of problems and reinforces the need for effective interventions to be implemented in schools to address the high prevalence of children and adolescents engaging in bullying behaviours.