Introduction

Top Abstract Introduction Participants and methods Results Discussion References

Recent reports have highlighted the frequency of bullying in schools and the adverse consequences on bullying behaviour in adolescence.^1-7 Despite the efforts of schools to prevent or stop bullying, it still occurs worldwide. ^{2 8-10} Victims of frequent bullying have been reported to experience a range of psychological, psychosomatic, and behavioural symptoms including anxiety and insecurity,¹¹ low self esteem and low self worth, ^{2 3 12} considerable mental health problems, sleeping difficulties, bed wetting, feelings of sadness, and frequent headaches and abdominal pain. ^{1 5} They are also more likely to be unhappy and depressed⁵ and absent from school.¹³

Although definitions of bullying behaviour vary, bullying has been defined as the "intentional, unprovoked abuse of power by one or more children to inflict pain or cause distress to another child on repeated occasions."¹⁴ The most common form of bullying self reported by Australian students is verbal harassmentfor example, teasing and name calling.¹³ This is consistent with students in Norway¹⁵ and England.¹ Most students do nothing to help victims because they feel it is not their place to get involved. ^{16 17}

Reported estimates of bullying vary owing to differences in the type of measurements taken and the sex, age, and ethnic origin of students studied. For example, in Newham, east London, 22% of young people had been bullied at some time.¹ In Yorkshire, 21% of children had been bullied and about 17% had taken part in bullying others "sometimes or more often."¹⁸ Another study in the United Kingdom found these rates to be 4.2% and 3.4% respectively.¹¹ The weekly incidence of bullying in Australian schools has been estimated at about 1 in 6 children during any one year.¹⁶ Bullying has been found to decrease with age, with boys more likely to have been bullied and to participate in bullying others compared with girls. ^{5 11 13 18} Bullies are more likely to dislike school and to engage in behaviours that compromise their health such as smoking and drinking alcohol to excess.⁵ According to the problem behaviour theory, bullying others may be one of a cluster of problem behaviours.¹⁹

Our study sought to identify the prevalence of bullying behaviours among schoolchildren in New South Wales, Australia, and the association of bullying with psychological and psychosomatic health. Our study differs from earlier ones by differentiating students involved in bullying behaviour from those who bully and are themselves bullied, those who only bully, those who are only bullied, and those who are neither bullies nor bullied.

	Participants and methods

Top Abstract Introduction Participants and methods Results Discussion References

Participants
Analyses are based on a statewide sample of year 6 (primary) and year 8 and year 10 (secondary) students attending one of 115 Catholic, government, and independent schools. We stratified the schools into primary and secondary schools, and we selected those to participate through cluster random sampling defined by school class.

Methods
We randomly selected one class from each selected school year according to the World Health Organisation's survey protocol for health behaviour among schoolchildren.⁵ The self administered surveys were completed in classrooms under exam-like conditions in October and November 1996, at the end of the last term (term 3) of the Australian school calendar.

Survey methods
The survey was administered statewide by health promotion staff of the New South Wales Health Department. The questionnaire was adapted²⁰ from the WHO's health behaviour survey in schoolchildren, which has been shown to be valid and reliable in Europe for over a decade.⁵ The core questionnaire was validated for Australian conditions in 1992 and 1996.²⁰ Questions from the instrument that are the focus of our report relate to demographics, bullying, psychosomatic symptoms, mental health, and school and social contact.

Categorisation of bullying behaviours
Bullying behaviours were the dependent variables. We used the following definition: "Bullying is when another student, or group of students, says or does nasty and unpleasant things to him or her. It is also bullying when a student is teased repeatedly in a way he or she doesn't like. But it is not bullying when two students about the same strength quarrel or fight."²⁰ Students were asked to respond to two questions: have you ever been bullied in school this term? and, how often have you taken part in bullying other students in school this term? We dichotomised responses into students who had not experienced bullying behaviour or who had (once or more). We then further classified the students into four groups as bullies, bullied, both bullies and bullied, and neither bullies nor bullied.

Psychosomatic symptoms
Students were presented with a series of health symptoms (headache, stomach ache, backache, feeling low, irritable or bad temper, feeling nervous, difficulties getting to sleep, feeling dizzy) and asked to report the frequency with which they experienced each. These items were summed to form a unit weighted psychosomatic symptom scale, and frequency of symptoms was categorised as: low scores (0-4; up to three symptoms less than once a month or never); moderate (5-8; four or more symptoms about every month or up to three per week); frequent (9-14; four or more symptoms once per week or up to three per week); and high (15-32; four or more symptoms more than once a week or about every day) (mean 8.5 (SD 6.3)). The Cronbach's  of the scale was 0.81.

Dichotomised responses
Smoking Current smoking was identified by asking the students how often they smoked at present. We dichotomised responses as less than weekly and once or more per week.

Statistical analysis
We assessed the prevalence of the studied items by sex and school year with descriptive univariate statistics produced by SPSS release 6 software. The selected independent variables were dichotomised as healthy and non-healthy, and we examined their associations with bullying behaviours.

	Results

Top Abstract Introduction Participants and methods Results Discussion References

Sample characteristics
Complete questionnaires were received from 3918 students2129 girls (54.3%), 1764 boys (45.0%), and 25 (0.64%) not specifiedrepresenting a participation rate of 84% on the basis of enrolment figures for secondary school years 8 and 10, and 88% for primary school year 6. The mean age of our sample was 11.88 years (SD 0.52) for year 6 students, 13.96 (0.54) years for year 8 students, and 15.97 (0.51) years for year 10 students. Boys and girls in each year were of identical age. Student distribution across the school years was similar: 1222 students in year 6 (31.1%), 1403 in year 8 (35.8%), and 1268 in year 10 (32.4%). Overall, 443 students (11.3%) were born overseas, 3381 (86.3%) were born in Australia, and 94 (2.4%) were from an indigenous background.

Prevalence of bullying behaviours
Table 1 presents the unadjusted prevalence of bullying behaviours and the studied variables by school year and sex. Table 2 presents the results from the multinomial logistic regression of students who bullied, who were bullied, and who were both bullied and bullied others. We used the group of students who reported neither having been bullied nor bullying other students as the comparison group.

Bullies
After adjusting for survey sampling and the other social and psychological factors in our model, significantly more boys than girls were bullies (relative risk ratio 2.0); bullies experienced frequent (1.6) and high scores for psychosomatic symptoms (1.8), were current smokers (1.5), spent four days or more with friends after school (1.2), and spent three or more evenings out with friends (1.4). Bullies were significantly more likely to be in year 6 than years 8 or 10 (0.65 and 0.48 respectively), did not like school (0.48), and did not think that school was a nice place to be (0.55) (table 2).

Bullied students
Those who were bullied were more likely to be boys than girls (1.3), to be lonely (1.7), and to find themselves alone because other students did not want to spend time with them at school (3.4). Bullied students were less likely to be in year 8 (0.71) or year 10 (0.32), spent three or more evenings out with friends (0.52), did not like school (0.57), were current smokers (0.38), and missed days from school without permission from their parents (0.48) (table 2).

Bullied students who also bullied
Students who were both bullied and bullied others were significantly more likely to be boys (2.1), experienced frequent (1.6) and high scores for psychosomatic symptoms (2.0), reported being alone (2.5), were current smokers (1.8), and spent three or more evenings out with friends (1.4). These students were significantly less likely to be in year 8 (0.65) or year 10 (0.28), to spend time with friends after school (0.68), to feel school was a nice place to be (0.50), and to like school (0.57) (table 2).

	Discussion

Top Abstract Introduction Participants and methods Results Discussion References

Our results indicate that, in one term of the school year, more than three out of five students experienced or participated in bullying in schools in New South Wales. The estimate of 13% of students as victims of bullying is less than that reported in English schools, although this number increased substantially to 34% when we included students who both bullied and were bullied. Exposure to bullying may be substantial for those who are bullied as there were more students who bullied (but not also bullied) than students who were bullied.

Our results show a statistically significant association between bullying behaviour and psychosomatic symptoms and smoking, with those students who both bullied and were bullied reporting the highest frequency of symptoms. Bullies tended to be unhappy with school, and students who were bullied tended to like school more and to report feeling alone. Unsurprisingly, students who both bullied and were bullied exhibited the characteristics of disliking school and feeling alone, and they seemed to have the most psychological and psychosomatic symptoms.

Although our results are cross sectional, they are consistent with other findings that have identified bullied children as having few friends, being more introverted than others, and generally lacking social skills. ^{2 13} Bullies also deserve attention. Dawkins says that bullying may be one component of a more general pattern of antisocial and rule breaking behaviour that shows considerable stability over time,¹⁴ although our data do not address this point.

As suggested by others, ^{1 14} health practitioners evaluating students with common psychological and psychosomatic symptoms should consider bullying and the student's school environment as a potential cause. A positive school environment may increase health promoting behaviours ^{1 22} and it is likely that bullying and its consequences can be reduced if the school does not tolerate bullying. Engaging the assistance of children not involved in bullying may help to reduce tolerance of bullying and change the normal attitudes around bullying. Studies of policies and strategies that effectively reduce bullying are needed.

	Acknowledgments

We thank all the schools, staff, and students who participated, the health promotion staff throughout New South Wales who assisted with data collection, and Ms Philayrath Phonsavan, who coordinated the data management.

Contributors: AB and LM initiated the study, designed the protocol and materials, collected and collated the data, and carried out reference study No 20. RF developed the model and conducted the multinomial logistic regression analysis. LM conducted univariate data analysis. RF, LM, CR, and AB interpreted the results, discussed their meaning, and contributed to the writing and editing of this manuscript. CR and RF contributed to reference study No 20. AB will act as guarantor for the paper.

	Footnotes

Funding: Epidemiology Unit, South Western Sydney Area Health Service. The health promotion branch of the New South Wales Health Department provided a small grant for the printing of the surveys.

Competing interests: None declared.

	References

Top Abstract Introduction Participants and methods Results Discussion References

1.	Williams K, Chambers M, Logan S, Robinson D. Association of common health symptoms with bullying in primary schoolchildren. BMJ 1996; 313: 17-19[Abstract/Free Full Text].
2.	Rigby K, Slee PT. Dimensions of interpersonal relating among Australian schoolchildren and their implications for psychological well-being. J Soc Psychol 1993; 133: 33-42[Medline].
3.	Boulton MJ, Smith PK. Bully/victim problems among middle school children: stability, self perceived competence, and peer acceptance. Br J Dev Psychol 1994; 12: 315-329.
4.	Mynard H, Joseph S. Bully/victim problems and their association with Eysenck's personality dimensions in 8- to 13-year-olds. Br J Educ Psychol 1997; 67: 51-54.
5.	King A, Wold B, Tudor-Smith C, Harel Y. The health of youth: a cross-national survey , 1996(WHO Regional Publications, European Series No 69.)
6.	Zubrick SR, Silburn SR, Gurrin L, Teoh H, Shepherd C, Carlton J, et al. Western Australian child health survey: education, health and competence. Perth, WA: Australian Bureau of Statistics and Institute for Child Health Research , 1997.
7.	Olweus D. Bullying at school: basic facts and an effective intervention programme. J Child Psychol Psychiatry Allied Disciplines 1994; 35: 1171-1190[Medline].
8.	Smith PK, Sharp S. School bullying: insights and perspectives. London: Routledge , 1994.
9.	Oliver R. Family issues of interventions in bully and victim relationships. Sch Counsellor 1994; 41: 199-202.
10.	Neary A. Peer victimization and its relationship to self-concept and depression among school girls. Pers Individual Differences 1994; 16: 183-186.
11.	Salmon G, James A, Smith DM. Bullying in schools: self reported anxiety, depression, and self esteem in secondary school children. BMJ 1998; 317: 924-925[Free Full Text].
12.	Rigby K. Peer relations at school and the health of adolescents. Youth Stud Aust 1998; 17: 13-17.
13.	Rigby K. What children tell us about bullying in schools. Child Aust 1997; 22: 28-34.
14.	Dawkins J. Bullying in schools: doctors' responsibilities. BMJ 1995; 310: 274-275[Free Full Text].
15.	Olweus D. Bullying at school. Oxford: Blackwell , 1993.
16.	Rigby K. Bullying in Australian schoolsand what to do about it. Melbourne, NSW: Australian Council for Educational Research , 1996.
17.	Whitney I, Smith PK. A survey of the nature and extent of bullying in junior/middle and secondary schools. Educ Res 1993; 35: 3-25.
18.	Boulton MJ, Underwood K. Bully/victim problems among middle school children. Br J Educ Psychol 1992; 62: 73-87.
19.	Jessor R, Jessor SL. Problem behaviour and psychosocial development. A longitudinal study of youth. New York: Academic , 1977.
20.	Bauman A, Hogan A, McLellan L, Rissel C, Mayne D, Gill L, et al. Health behaviours of New South Wales school students: report of the NSW health behaviour of school students (NSW HBSS) survey, 1996. Sydney, NSW: National Centre for Health Promotion , 1998.
21.	Eltinge JL, Sribney WM. Versions of mlogit, ologit, and oprobit for survey data. Stata Stat Bull 1997; 40: 39-42.
22.	Nutbeam D, Smith C, Moore L, Bauman A. Warning! Schools can damage your health: alienation from school and its impact on behaviour. J Paediatr Child Health 1993; 29(suppl.1): 25-30S.

(Accepted 4 May 1999)