case study on bully

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

A Case Study with an Identified Bully: Policy and Practice Implications

• Huddleston, Lillie B ;
• Varjas, Kris ;
• Meyers, Joel ;
• Cadenhead, Catherine

Objective: Bullying is a serious public health problem that may include verbal or physical injury as well as social isolation or exclusion. As a result, research is needed to establish a database for policies and interventions designed to prevent bullying and its negative effects. This paper presented a case study that contributed to the literature by describing an intervention for bullies that has implications for research, practice and related policies regarding bullying.

Methods: An individualized intervention for an identified bully was implemented using the Participatory Culture-Specific Intervention Model (PCSIM; Nastasi, Moore, & Varjas, 2004) with a seventh-grade middle school student. Ecological and culture-specific perspectives were used to develop and implement the intervention that included psychoeducational sessions with the student and consultation with the parent and school personnel. A mixed methods intervention design was used with the following informants: the target student, the mother of the student, a teacher and the school counselor. Qualitative data included semi-structured interviews with the parent, teacher and student, narrative classroom observations and evaluation/feedback forms filled out by the student and interventionist. Quantitative data included the following quantitative surveys (i.e., Child Posttraumatic Stress Reaction Index [CPTS-RI] and the Behavior Assessment Scale for Children, 2nd Edition). Both qualitative and quantitative data were used to evaluate the acceptability, integrity and efficacy of this intervention.

Results: The process of intervention design, implementation and evaluation are described through an illustrative case study. Qualitative and quantitative findings indicated a decrease in internalizing, externalizing and bullying behaviors as reported by the teacher and the mother, and a high degree of acceptability and treatment integrity as reported by multiple stakeholders.

Conclusion: This case study provided important contributions by describing an intervention that is targeted to specific needs of the bully by designing culture specific interventions and working with the student’s unique environmental contexts. Additional contributions included the use of mixed methods to document acceptability, integrity and efficacy of an intervention with documented positive effects in these areas. In addition, implications for policy and practice related to the treatment of students identified as bullies and future research needs are discussed. [West J Emerg Med 2011; XX(X)XX-XX].

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Open Access

Peer-reviewed

Research Article

Bullying experiences in childhood and health outcomes in adulthood

Roles Conceptualization, Formal analysis, Investigation, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

Affiliation Institute of Social Science, University of Tokyo, Tokyo, Japan

Roles Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Validation, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

• Yurie Momose, 
• Hiroshi Ishida

• Published: July 15, 2024
• https://doi.org/10.1371/journal.pone.0305005
• Reader Comments

This study examines whether the experience of being bullied at school has a long-term impact on three health outcomes in adulthood in Japan: subjective health, mental health, and activity restriction due to health conditions. We employed a random effects model and the Karlson-Holm-Breen method to decompose the total effect of being bullied at school on health inequality into a direct effect and an indirect effect working through intervening factors including education, marriage, economic well-being, and social networks. We used the Japanese Life Course Panel Surveys 2007–2020 (waves 1–14), a nationally representative panel data set that includes 2,260 male and 2,608 female respondents. The results demonstrate that for both men and women, the direct effect of being bullied at school was strong and significant. Bullying experiences in childhood had a long-term impact on health outcomes in adulthood, regardless of social background and mediating factors of education, marriage, economic well-being, and social networks. Bullying victimization increased the risk of poor subjective health, low mental health scores, and activity restriction due to health conditions. Intervening factors (especially economic well-being and friendship) mediated the association between bullying experiences and all health outcomes, but their contributions were modest. Policy measures not only to prevent bullying during childhood but also to alleviate its negative consequences in adulthood should be considered to help people who have encountered adverse childhood experiences.

Citation: Momose Y, Ishida H (2024) Bullying experiences in childhood and health outcomes in adulthood. PLoS ONE 19(7): e0305005. https://doi.org/10.1371/journal.pone.0305005

Editor: Alejandro Botero Carvajal, Universidad Santiago de Cali, COLOMBIA

Received: January 13, 2024; Accepted: May 21, 2024; Published: July 15, 2024

Copyright: © 2024 Momose, Ishida. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The panel surveys analyzed in the current study are available from the Social Science Japan Data Archive (SSJDA), Center for Social Research and Data Archives, University of Tokyo. To access the datasets, researchers must register at SSJDA Direct ( https://ssjda.iss.u-tokyo.ac.jp/Direct/?lang=eng ). Instructions for utilizing SSJDA Direct can be found at the following URL: https://csrda.iss.u-tokyo.ac.jp/english/infrastructure/access/apply.html . The dataset numbers and titles are as follows: "PM140 Japanese Life Course Panel Survey for the Middle-aged (JLPS-M), wave1-14, 2007-2020" and "PY140 Japanese Life Course Panel Survey for the Youth (JLPS-Y), wave1-14, 2007-2020." Researchers are required to integrate the two datasets.

Funding: This research was supported by KAKENHI Grant-in-Aid for Specially Promoted Research (Grant Numbers JP25000001 and JP18H05204) and Scientific Research (S) (Grant Numbers JP18103003 and JP22223005) from the Japan Society for the Promotion of Science (JSPS) to HI. HI obtained the research support in conducting the panel surveys from the Institute of Social Science, University of Tokyo. YM acknowledges the Research Fellowship for Young Scientists (22J10114) from the JSPS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

1. Introduction

1.1 bullying and health inequalities.

Adverse childhood experiences (ACEs) refer to a set of negative events that individuals encounter during childhood and are known to be associated with health inequality. A large body of research documents the association between ACEs and the risk of negative health consequences [ 1 – 6 ]. Traditionally, the focus of research on childhood trauma and negative events has been on acute or exceptionally high-stress events such as parental death and abuse [ 7 – 10 ]. In recent years, among a variety of ACEs, being the victim of bullying in childhood has received increasing attention [ 11 – 14 ]. It is widely recognized that bullying experiences can have a wide range of effects. For example, being a victim of bullying has an impact on the well-being of children, including subjective health, life satisfaction, anxiety disorders, depression, physical symptoms, sleep disturbances, loneliness, social isolation, low self-esteem, feelings of hopelessness, self-harm, and aggression.

Bullying experiences at schools are recognized as a significant social concern, affecting about one in three adolescents worldwide [ 15 ]. Japanese people are believed to be less likely than Americans to commit any kind of deviant behavior [ 16 ]. However, Kobayashi and Farrington [ 17 ] reported that Japanese students tended to bully more than American students because they had more tolerant attitudes toward bullying. Similarly, Yoneyama and Naito [ 18 ] summarized the prevalence of bullying in Japan, claiming that bullying involving the entire class was one of the most common forms of bullying in Japan. According to a survey conducted by Iwanaga et al. [ 19 ], 42% of Japanese adults living in a metropolitan area, who participated in the study, reported being victims of bullying during their elementary and middle school years. These results confirm that bullying stands as one of the most significant educational and social challenges in Japan.

The experience of bullying can negatively affect social factors such as educational attainment and socio-economic status, create difficulties in building social networks due to social isolation, and result in dissatisfaction with human relationships [ 20 – 22 ]. Research on the association between bullying experiences and health has mainly focused on mental health [ 23 , 24 ], with comparatively little evidence about the effects on individuals’ physical health [ 14 , 25 , 26 ]. Even though an increasing number of studies reveal long-lasting impacts of bullying victimization, the effects appear to be mixed, and the mechanisms are not readily apparent [ 22 ].

This growing attention to bullying experiences is related to a surge in research examining the physical and mental health effects of trauma and negative events over the past 50 years [ 27 ]. Priest et al. [ 28 ] found that the combined and cumulative experiences of bullying victimization and racism exacerbate the risks to mental and physical health. Wolke and Lereya [ 22 , p.879] contend that “being bullied is still often wrongly considered as a ‘normal rite of passage’” and that childhood bullying has been ignored as a major public health concern. Due to these findings, the importance of examining the link between bullying and health status has increased over the years, extending even to researchers focusing on health inequalities.

1.2 Long-term effects of bullying in adulthood

In recent years, there has been growing concern that bullying victimization can have negative consequences not only during childhood but also throughout one’s life. According to a review by Arseneault [ 29 ], the effects of being bullied may persist even after the bullying has stopped. Smokowski and Kopasz [ 30 ] summarized research on bullying and concluded that victims of bullying in childhood suffer long-term effects on adult mental health, including anxiety, depression, substance use, and behavioral disorders. They suggested that addressing bullying can not only reduce mental health symptoms in children, but also prevent mental health problems in adulthood. Their review further argued that bullying should be seen as another form of childhood abuse, along with parental physical abuse and neglect. The experience of being bullied can lead to the worst possible consequences later in life, such as victims harming the lives of others by carrying a weapon [ 31 ], or engaging in interpersonal violence [ 32 ], or taking their own lives [ 33 – 35 ].

Recent research has expanded the investigation of the effects of ACEs on health disparities to include the elderly population. In this context, Hu [ 36 ] explored this topic, focusing on the consequences of childhood bullying experiences on the mental well-being and life satisfaction of Chinese individuals aged 60 years and above. The study emphasized that the detrimental effects of bullying victimization on depressive symptoms persist even after adjusting for confounding variables. However, it noted a potential reduction of these effects among the very elderly. Both Guo et al. [ 37 ] and Chen et al. [ 38 ] incorporated a comprehensive array of ACE factors, such as parental divorce, parental death, household mental illness, domestic violence, and bullying, among others, to assess their collective influence on the mental health of the elderly. Meanwhile, Li et al. [ 39 ] showcased how ACEs affect the activities of daily living among older adults.

Most of the prior research on ACEs typically amalgamated various adverse experiences, including bullying victimization, into a cumulative score to measure the overall extent of ACEs. This approach poses challenges in isolating the specific influence of bullying experiences. An exception to this trend is the study by Zhou and Zhou [ 40 ], which delineated the individual components of ACEs and explored the direct and indirect effects of childhood bullying experiences on mental health. Our study centers on childhood bullying victimization, assessing its influence not only on mental well-being but also on physical health outcomes in adulthood. We aim to investigate whether the pathways linking childhood bullying experiences to adult health outcomes differ depending on whether mental or physical health is affected.

In addition, many studies have incorporated gender differences into their analytical frameworks, given that prior research on bullying encouraged the inclusion of gender as a factor in the analysis [ 41 ]. Cao et al. [ 42 ], having studied the impact of bullying on mental health, broke down the effects of bullying on suicidal ideation into direct effects and indirect effects mediated by loneliness, finding that women were more likely to suffer from psychological maladjustment after being victims of bullying. Other studies found that women are more likely to experience the detrimental effects of frequent bullying and have a higher incidence of depression [ 33 , 43 , 44 ]. In contrast, there are findings that indicate that men are more likely to be victims of bullying than women because they are more likely to be rejected by their peers, and that men also have poorer physical health due to bullying [ 45 – 47 ]. Furthermore, while boys are more likely to be the target of physical and verbal bullying, girls are more likely to encounter cyberbullying and relationship exclusion [ 48 ]. These studies suggest that neither women nor men have a monopoly on the suffering that bullying can induce, nor is it certain that one gender consistently encounters more severe consequences as a result of being bullied.

In summary, research on the health effects of bullying victimization at school has gained momentum in recent years, indicating emerging evidence of long-term physical and psychological consequences. However, the mechanisms behind the long-lasting effects of bullying experiences in childhood on health inequality in adulthood require further investigation. As stated by Shaw et al. [ 48 ], the negative effects of traditional and cyberbullying are well established, but it is not clear whether they result from the direct effect of bullying or from indirect effects via mediating factors in adulthood.

1.3 Contribution of our research

The present study aims to make three significant contributions. First, it reveals that the experience of being bullied at school during childhood yields enduring negative consequences that extend into adulthood in Japan. By focusing on the long-term ramifications of bullying, this study transcends the confines of school environments, shedding light on the need for interventions and support mechanisms for individuals who have endured past victimization. Previous studies [ 29 , 30 ] have emphasized the necessity of further understanding the mechanisms underlying the persistent negative outcomes of bullying. Drawing from positive psychology, which often explores social behavior, psychological resilience, and life satisfaction as avenues for preventing bullying in schools [ 49 ], this study extends beyond the school setting to provide insights into the post-school experiences of adult victims of bullying, enriching our understanding of their journey into adulthood.

Second, this study examines three key health outcomes, encompassing not only mental health but also subjective health and activity limitations. Whereas previous research on bullying and health inequality has predominantly centered on mental health [ 23 , 24 ], our study broadens the scope to address a wider spectrum of health disparities. In the realm of health, inequalities extend beyond mental well-being to cover subjective health perceptions and limitations in daily activities due to health issues. By considering these multifaceted health dimensions, this research contributes to a more comprehensive understanding of the impact of school bullying on individuals’ overall well-being.

Third, the study explores pathways linking childhood bullying to adult health by investigating both direct and indirect mechanisms through which bullying influences adult health. Apart from Zhou and Zhou [ 40 ], to the best of our knowledge, previous research has not decomposed the long-term impact of bullying on adult health into direct and indirect pathways. Zhou and Zhou [ 40 ] offered breakdowns of ACEs into components (including bullying experiences) and examined their specific effects. They found that the predominant path from childhood bullying experiences to adult mental health is direct (80%). Our research utilizes this finding as a benchmark.

However, there are notable differences between Zhou and Zhou’s study and our research: (1) While Zhou and Zhou examined the impact of adverse childhood experiences on mental health, our study explores both mental and physical health outcomes; (2) Zhou and Zhou utilized subjective variables, such as satisfaction with children and partners, social activities, and social support, as mediators, whereas our research incorporates objective life-course events, such as educational attainment, economic status, marriage, and the presence of social network ties. The differences in mediating factors between the two studies may lead to varying decomposition results. We posit that our study represents one of the first systematic examinations of the role of objective life-course events in mediating the association between childhood bullying experiences and adult health outcomes. By comprehending the diverse mediating pathways through life-course events, this research provides valuable insights for shaping future interventions and support mechanisms for individuals with a history of bullying victimization.

Data description.

The data set used in this study comes from the Japanese Life Course Panel Surveys (JLPS) 2007–2020 (waves 1 through 14), a nationally representative panel data set, conducted every year since 2007 (the continuous sample). The JLPS is composed of the youth sample (respondents aged 20 to 34 years in 2007) and the middle-aged sample (respondents aged 35 to 40 years in 2007). The JLPS added the refresh youth sample in 2019 in order to compensate for the aging of the original sample respondents. The refresh youth sample includes respondents who were aged 20 to 31 years in 2019. After deleting cases with missing values, 2,260 male respondents and 2,608 female respondents were used for the analyses. For further details regarding the JLPS, see Ishida [ 50 , 51 ] and Ishida, Arita, and Fujihara [ 52 ].

Sampling procedure.

The continuous sample and the refresh sample used an identical sampling procedure. Primary sampling units were selected following a process of stratification based on geographical regions (10 regions: Hokkaido, Tohoku, Kanto, Hokuriku, Tozan, Tokai, Kinki, Chugoku, Shikoku, and Kyushu) and urban classification (four categories: 16 largest cities, cities with populations exceeding 200 million, other cities, and towns/villages). From each sampling unit, respondents were selected using the Basic Resident Register and Electoral Register, which provided comprehensive lists of all residents. Before individual respondent selection, stratification by age (20–24, 25–29, 30–34, and 35–40) and gender (male and female) was conducted, ensuring adequate representation from each age and gender group. The respondents constituted a nationally representative sample of men and women across the targeted age groups [ 53 ].

The continuous sample yielded valid responses from 3,367 individuals for the youth sample and 1,433 individuals for the middle-aged sample. The response rates were 34.5% for the youth sample and 40.4% for the middle-aged sample. The refresh youth sample collected valid responses from 2,051 individuals, achieving a response rate of 35.6%. These respondents have been followed up annually, with retention rates of approximately 80% for the youth sample (for both the continuous and refreshed samples) and approximately 88% for the middle-aged sample.

Informed consent and IRB approval.

Respondents received an informed consent form by mail in January 2007 (for the continuous sample) and January 2019 (for the refresh sample), describing the study’s objectives and purpose, along with details regarding the confidentiality and anonymity of responses. This information was provided prior to the distribution of the questionnaires. Subsequently, the questionnaires were dispatched by mail to all participants, excluding those who opted out of the survey by responding negatively to the initial mail. Trained surveyors from a reputable survey firm conducted visits to the respondents and collected the completed questionnaires. In the case of the 2007 continuous sample, verbal consents were obtained, and these were duly documented by the surveyors at the time of collecting the completed questionnaires. For the 2019 refresh sample, written consents were procured and collected by trained surveyors. Respondents who did not provide consent were excluded from the sample.

The Institutional Research Ethics Review Board (the Research Ethics Review Committee) at the Institute of Social Science, The University of Tokyo, approved the Japanese Life Course Panel Surveys (JLPS) project. We declare compliance with the ethical practices described in the Code of Conduct for Research at The University of Tokyo.

2.2 Variables

We used three outcome variables: subjective health, mental health score, and no activity restriction. Subjective health was measured using the following question: “How do you feel about your general health?” This question does not specify whether it pertains to physical or mental health; it is intended to inquire about the respondent’s overall general health. Responses were coded as: “poor” (1), “not good” (2), “ordinary” (3), “good” (4), and “very good” (5). Fig 1 shows the distribution by gender, revealing that less than 20% of respondents reported poor or not good health, 46% ordinary health, and the remainder good or very good health. The distributions exhibit a near-identical pattern between male and female respondents.

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https://doi.org/10.1371/journal.pone.0305005.g001

Mental health scores were computed by summing the responses to five questions about the respondent’s mental state: “How often in the last month did you feel the following? A) Feeling quite nervous, B) Feeling so down in the dumps that nothing could cheer you up, C) Feeling calm and peaceful, D) Feeling downhearted and blue, and E) Feeling happy.” Responses were coded as “constantly” (1), “nearly constantly” (2), “occasionally” (3), “rarely” (4), and “not at all” (5). For items C and E, the response categories were reversed so that the higher the value, the better the mental state. The coefficient of reliability for these five items was 0.788 (Cronbach’s alpha), indicating an acceptable level of reliability. Fig 2 displays the distribution of mental health scores by gender. These show remarkable similarity up to a score of 50, after which point female respondents tend to exhibit slightly higher scores, indicating a better mental state than male respondents.

https://doi.org/10.1371/journal.pone.0305005.g002

The variable “no activity restriction” was coded using the question: “How often in the last month did you feel that activities like housekeeping and work were limited because of your health conditions?” Responses with “rarely” and “not at all” were coded as 1, and 0 otherwise. Fig 3 describes the distributions of activity restriction by gender. The figure clearly demonstrates that male respondents were more inclined to respond with “not at all” compared to female respondents, suggesting that men reported experiencing less restriction in their daily activities due to health issues than women.

https://doi.org/10.1371/journal.pone.0305005.g003

The treatment variable is the experience of bullying at school. Among the list of events which the respondents experienced, those who reported yes to the item, “I was bullied at school,” were coded 1, and 0 otherwise. A number of social background variables were included as controls. Father’s and mother’s educations were coded as 1 when they attended two-year junior college or four-year university and 0 otherwise. An indicator variable for “unknown” was included due to a relatively large number of cases with missing responses. The number of books at home when the respondent was 15 years old was used as an indicator of household cultural capital. We created two measures to capture economic well-being when the respondent was growing up. The first variable is a binary indicator signifying whether the respondent was living in a home owned by their parents when he/she was 15 years old. Second, a question about the standard of living when the respondent was 15 years old was coded as “wealthy” (5), “somewhat wealthy” (4), “average” (3), “somewhat poor” (2), and “poor” (1). Finally, a variable indicating whether the respondent had any life-restricting illness or disorder before he/she was 18 years old was created to measure baseline health conditions. These background variables are time-invariant and fixed for the entire period of the panel survey.

We also introduced a number of mediating variables. The respondent’s educational attainment was coded as 1 when the respondent attended institutions of higher education and 0 otherwise. This variable is time-invariant and did not change across waves. The following mediating variables are time-variant and may change across waves. Being unmarried was determined by a marital status question asked in every wave. Current living standard was measured by the self-reported standard of living in each wave: “wealthy” (5), “somewhat wealthy” (4), “average” (3), “somewhat poor” (2), and “poor” (1). Whether the respondent had a friend in every wave was used to determine the “currently has no friends” variable. Four network-related questions were asked to determine the extent of the respondent’s social network ties: “Who do you talk to when you want to discuss the following matters? A) about work or study, B) about job referrals, C) about relationships with friends and partners, D) about borrowing significant amounts of money when you are in need because of job loss or illness.” A list of possible people (such as parents, partners, children, and siblings) that the respondent may specify was provided. If the respondent replied “none,” the variable is coded as 1, and 0 when the respondent chose any one of the listed people. These four social network variables were labelled as follows: “no one to talk to about work and study,” “no one to talk to about job referral,” “no one to talk to about relationships,” and “no one to talk to about borrowing money.” These questions were asked every other wave.

Finally, age and age squared were included as controls. We also controlled for survey samples (youth sample, middle-aged sample, and refresh youth sample), and the waves (wave 1 to wave 14) but do not show these coefficients in the following tables. Descriptive statistics are shown in Table 1 .

https://doi.org/10.1371/journal.pone.0305005.t001

2.3 Statistical model

In order to decompose the effect of the treatment (bullying experiences) on the outcome, we use the Karlson-Holm-Breen (KHB) method [ 54 – 57 ]. We aim to estimate the share of the direct and indirect pathways in the total effect. However, a comparison of the total and direct effects of the treatment on the outcome in nested nonlinear models is affected by both confounding due to mediating variables and rescaling of the model. In other words, when a mediating variable is included in a nonlinear equation model, the coefficient of the treatment variable can change, regardless of whether it is correlated with that mediator, as long as the mediator is correlated with the outcome. To address different scaling across models, we employ the KHB method. This method not only estimates the effect of confounding (the indirect portion) net of rescaling but also provides a statistical test for the indirect effect. Other decomposition methods often lack a statistical test for indirect component [ 58 ]. Because our analyses include both linear and nonlinear equations, the KHB method emerges as the most suitable for decomposition [ 59 ]. This method has been used extensively not only in the sociological literature but also in health sciences [ 37 , 38 , 40 ].

Tables 2 – 4 shows the results of fitting two models by gender separately for three health outcomes. The first model predicts health outcomes by the treatment variable (bullying at school) and confounding variables (social backgrounds). The second model predicts health outcomes by bullying at school, social background variables, and mediating variables.

https://doi.org/10.1371/journal.pone.0305005.t002

https://doi.org/10.1371/journal.pone.0305005.t003

https://doi.org/10.1371/journal.pone.0305005.t004

We begin with the first health outcome, subjective health, in Table 2 . Let us focus on the first row, the coefficients for the school bullying variable. For both male and female respondents, the effect of bullying at school is negative and significant after controlling for social background (Model 1). The experience of being bullied during childhood is associated with worse subjective health in adulthood. After introducing mediating variables, the effect of bullying at school is reduced slightly for men and women (Model 2). However, the effect of bullying experiences continues to be substantial and statistically significant. The experience of school bullying affects subjective health regardless of education, marriage, economic well-being, and social network.

We next report the results for the second health outcome, mental health ( Table 3 ). Just like the results for subjective health, for both men and women the effect of bullying experiences at school is negative and significant after social background variables are controlled. After introducing mediating variables, the effect of bullying experiences is reduced but remains substantial and statistically significant. The experience of being bullied during childhood is associated with a worse mental health state in adulthood, even after social background and mediating experiences of education, marriage, economic status, and social network are controlled for.

Finally, we show the results for the third health outcome, no activity restriction ( Table 4 ). For both men and women, the school bullying variable exerts a negative and significant effect on no activity restriction after controlling for social background, and further after controlling for mediating variables. The introduction of mediating variables reduces the effect of school bullying for male respondents, but hardly changes the effect for female respondents. These results indicate that the experience of school bullying reduces the odds of having no activity restriction in adulthood, even after accounting for all confounding and mediating factors. In other words, people who had childhood experiences of bullying are more likely to experience activity restriction due to health conditions.

The findings in Tables 2 – 4 emphasize that negative influences associated with childhood bullying experiences at school transcend the school environment and endure well into adulthood. These consequences manifest across various domains, encompassing mental health, subjective health assessments, and constraints in daily activities attributable to health concerns.

Table 5 reports the results of the decomposition of the effect of school bullying using the KHB method. There are three panels for three health outcomes: subjective health, mental health, and no activity restriction. The row labelled “Reduced” indicates the total effect of bullying at school after social background variables are controlled, “Full” indicates the direct effect of bullying after mediating factors are introduced, and “Difference” indicates the indirect effect of bullying through mediating factors. The Reduced effects are slightly different from the effects reported in Tables 2 – 4 because they adjust for re-scaling. The Full effects are the same as those reported in Tables 2 – 4 .

https://doi.org/10.1371/journal.pone.0305005.t005

The decomposition of the effect on subjective health (left-hand side panel of Table 5 ) reveals that the extent of indirect effect (the proportion of Difference to Reduced in Table 5 ) is 0.255 for males and 0.110 for females. In other words, about a quarter of the total effect of bullying at school on subjective health among men, and about one tenth among women, are explained by mediating factors. As shown in Table 2 , among the mediating variables, the following exert significant impact on subjective health for both males and females: being unmarried, having no friends, and lower economic well-being. These factors partially account for why bullying experiences influences subjective health.

The middle panel of Table 5 shows the decomposition of the effect of school bullying on mental health. The indirect effect through mediators comprises 16% of the total effect of bullying for male respondents and 12% for female respondents. A modest but significant portion of the association between school bullying and mental health is thus explained by mediating factors. Among these mediators, marriage, economic well-being, and some social network variables significantly affect mental health, suggesting that they play an important role in mediating the influence of school bullying on mental health.

Finally, the right-hand side panel of Table 5 presents the decomposition of the effect of school bullying on no activity restriction. The indirect effect comprises 13% of the total effect for men and virtually none for women. Among men, economic well-being and having no friends appear to mediate the association between school bullying and no activity restriction as shown in Table 4 . Among women, the impact of school bullying is entirely direct without going through mediating factors.

In summary, the results in Table 5 indicate that life-course events, including educational attainment, economic status, marriage, and the presence of social network ties, partially explain the connection between childhood bullying experiences and adult health outcomes. However, our analysis reveals that the primary pathway linking childhood bullying to adult health is direct, rather than being mediated by these life-course events.

4. Discussion

Our study first demonstrates that the experience of being bullied at school has enduring negative consequences for health outcomes in adulthood in Japan. The impacts of school bullying extend beyond the school environment and persist into adulthood. Second, our findings reveal that these enduring influences are not limited to mental health but also encompass subjective health perceptions and limitations in daily activities due to health issues, highlighting the multidimensional aspects of health inequalities that are at risk. Third, our research uncovers pathways from childhood experiences of school bullying to adult health inequalities. Individuals who were victims of school bullying continue to suffer from poor health outcomes in adulthood, both through their life-course experiences and through pathways independent of these events. Notably, the primary pathway remains direct, bypassing objective life-course events such as educational attainment, economic status, marriage, and the presence of social network ties.

Our analyses reveal that the experience of being bullied during childhood is associated with worse subjective health, lower mental health status, and activity restriction in adulthood for both men and women. The decomposition analysis shows that the impacts of school bullying are primarily direct: the experience of school bullying continues to affect all three health outcomes regardless of education, marriage, economic well-being, or social network. We also find three distinct paths linking bullying experiences in childhood to health outcomes in adulthood.

The first path goes through socio-economic attainment. People who were victims of bullying during childhood tend to have lower education and worse standard of living that in turn lead to deteriorating health outcomes compared to those without the experience of bullying. Disadvantaged socio-economic status, especially lower economic well-being, acts as the key mediating factor. The second path pertains to family events, and we considered the role of marriage. Marriages are associated with better health conditions, but individuals with bullying experiences in childhood are less likely to get married than those without such experiences. The lower chances of marriage among bullying victims result in worse health outcomes.

The third path goes through social network ties. The likelihood of having a friend or not turned out to be a crucial factor in the pathway from bullying to health outcomes. People with the experience of bullying at school are more likely to have no friends than those without bully experiences, and the lack of friendship relationships leads to worse health conditions. However, even after taking all these intervening factors together, the indirect paths explain only a small portion of the association between school bullying and health inequalities. This result suggests that there are other possible paths linking bullying experiences in childhood to adult health conditions.

With regard to gender differences, our results suggest virtually no gender differentiation in the extent of the association between school bullying and health outcomes and the decomposition pattern except for one instance where the indirect effect on activity restriction was not significant among women. Overall, the persistent effects of bullying into adulthood and the role of mediating factors in explaining the underlying mechanisms are similar between men and women.

Our findings parallel those of previous research [ 11 – 14 , 22 – 24 , 26 , 60 ], which reported that the experience of bullying at school had lasting effects on mental and physical health years later. Bullying victimization is associated with deteriorating health outcomes in adulthood. On the other hand, our study shows that the ability of mediating factors to explain the relationship between school bullying and health outcomes is modest. Previous studies have emphasized the significant role played by intervening factors, particularly within the school setting. Chai et al. [ 11 ] showed that relationships with parents, teachers, and peers were important mediators, and Varela et al. [ 13 ] reported on the importance of the school level socio-economic status. However, our data set did not contain detailed information about the schools attended by the respondents.

Our findings align with those of Zhou and Zhou [ 40 ], who indicated that the principal route from childhood bullying experiences to adult mental health is direct. We observed a comparable pattern across three health outcomes, encompassing both mental and physical health. However, while Zhou and Zhou focused on subjective variables as mediating factors, such as satisfaction with children and partners, social activities, and social support, our research instead highlighted objective life-course events, including educational attainment, economic status, marriage, and the presence of social network ties. Our study represents one of the first systematic examinations of the role of objective life-course events in mediating the association between childhood bullying experiences and adult health outcomes. Despite the difference in mediating factors, both studies suggest that these mediators explain only a modest portion of the observed association between childhood bullying victimization and adult health outcomes. Objective life-course events did not significantly outperform subjective satisfaction in this regard. Both factors made modest contributions to explaining the association under investigation. This implies the potential existence of additional mediators not accounted for in these studies.

Sweeting et al. [ 60 ] found that negative experiences in childhood, such as bullying and abuse, can lead to later negative life events like serious accidents, illness, and divorce, which, in turn, affect mental and physical health in adulthood. However, it should be noted that Sweeting et al. [ 60 ] used the cumulative number of high-level stress events as mediating factors, while our study did not include a range of adverse experiences that happened during adulthood. By excluding these adult experiences as intervening factors, our study may have overestimated the direct association between bullying in childhood and health outcomes in adulthood. As Wolke and Lereya [ 22 ] summarized in their review, the children of the victims of school bullying were found to exhibit lower educational attainment, diminished earnings, decreased job retention rates, and worse financial management skills. Our study also indicates that school bullying experiences are associated with low education, low economic well-being, and weaker social network ties. However, these observations contribute to explaining only a small part of the overall association between bullying and health outcomes in our study.

Studies on the long-lasting impacts of ACEs suggest possible psychosocial mechanisms linking the associations between ACEs and health. Bourassa et al. [ 61 ] affirmed that psychosocial factors including stressful life events, subjective stress level, negative emotionality, and health behaviors (smoking, physical activity, diet, and alcohol consumption) play an important mediating role. Karatekin and Ahluwalia [ 62 ] found that ACEs are associated with higher levels of perceived stress and lower levels of social support that lead to worse mental health scores. These studies suggest that the experience of bullying victimization can lead to adverse impacts on a wide range of economic, social, and psychosocial characteristics that may act as mediating factors. Research into identifying these intervening factors has just begun, highlighting the need for further investigation in the future.

Our study points out that the experience of being bullied as a child is an important risk factor for increasing health inequalities. Given the life-long negative health impacts of bullying, as Arseneault [ 29 ] pointed out, while traditional bullying prevention and intervention programs may improve the lives of young victims currently attending school by reducing the likelihood of being bullied, they are unlikely to solve the problems of those who were victimized in the past. There is an imminent need to consider relief systems and policies for past victims of bullying at school. According to Idsoe et al. [ 63 ], research on post-traumatic stress disorder (PTSD) symptoms related to school bullying has been limited, and their own study did not reveal PTSD symptoms persisting into adulthood. Further investigation is necessary to understand how PTSD symptoms resulting from bullying victimization at school can be mitigated.

There are several limitations to this study. First, as stated above, we had a modest number of intervening factors that mediate the association between bullying experiences in childhood and health outcomes in adulthood. The inclusion of other possible mediators is most likely to reduce the direct effect of bullying on health outcomes. The JLPS asked questions on a range of work-related factors such as working hours, training opportunities, and workplace conditions. Adverse workplace relationships, especially the presence of an oppressive boss and uncooperative colleagues, for example, may trigger the recollection of bullying incidents in childhood. These variables provide clues about how childhood bullying experiences are ultimately linked to adult health conditions.

Second, we considered bullying experiences at school as an example of ACEs. However, there are other sets of negative experiences, such as parental death, parental separation and divorce, physical and psychological abuse, physical and mental neglect, family substance misuse and mental disorders, and domestic violence. Future research should study the cumulative impacts of a wider range of adverse experiences. Third, because the issue of bullying at school pertains to experience during childhood, there is a possibility of recall bias [ 7 ]. People with certain characteristics (such as personality traits) which are related to health outcomes may have better memory than those without those characteristics.

Fourth, this study did not consider the problem of sample attrition of respondents. As the panel survey extends over several years, there is a tendency for some respondents to discontinue their participation in the survey. It is possible that people with health problems are more likely to drop out of the survey. Previous research [ 64 ] which examined the factors associated with attrition in the JLPS survey reported that young men and people who had plans to move their residence were more likely to drop out of the survey. However, it did not consider health status as one of the determinants of attrition, so the impact of health status on attrition is unknown. These issues warrant attention in future studies.

5. Conclusion

This study suggests that the experience of being bullied at school during childhood has long-lasting impacts on health outcomes in adulthood. The associations between bullying and health outcomes persist regardless of social background and mediating factors of education, marriage, economic well-being, and social networks. Policy measures aimed at not only preventing childhood bullying but also mitigating its adverse consequences in adulthood should be considered to assist individuals who have endured such experiences.

We can draw two significant policy implications from our findings. First, given that bullying can have both immediate and enduring health consequences, it becomes imperative to proactively prevent its occurrence within school environments. The active engagement of teachers and parents is pivotal in mitigating the risk of bullying. The Ministry of Education should articulate a clear definition of bullying and provide comprehensive guidelines for its prevention, ensuring that every school can implement them effectively. Local government, including the board of education, must also actively participate in efforts to mitigate the risks of bullying within schools. In cases of severe bullying incidents, reporting to the police may be necessary. Equipping teachers with training programs to identify early signs of bullying can deter its persistent manifestation. A unified commitment from teachers, counselors, social workers, parents, and students to combat bullying is essential for its eradication from school premises.

Second, support interventions are needed for adults who endured bullying during their youth. Focusing solely on at-risk school children is insufficient. The issue of bullying extends beyond the confines of schools, and it is crucial to acknowledge that its effects can persist beyond school settings. Our results suggest that social network ties play an important mediating role. Broader support networks encompassing family, friends, and counseling resources should thus prove effective. As adults transition from school to work, they typically spend a substantial amount of their social life in the workplace. Although this is not directly addressed in our analysis, workplace conditions and support networks at work hold promise as intervention avenues for adults who endured bullying during their youth.

Finally, it is also important to conduct a follow-up survey targeting children who have encountered bullying at school. Adults who were previously victims of bullying at school require targeted long-term care and support initiatives. By acknowledging and addressing the unique challenges and circumstances faced by adults who suffered from bullying victimization during their formative years, targeted interventions can ensure that support is extended where it is most needed.

Supporting information

S1 file. data availability statement..

https://doi.org/10.1371/journal.pone.0305005.s001

S2 File. Ethics approval document.

https://doi.org/10.1371/journal.pone.0305005.s002

S3 File. Ethics statement.

https://doi.org/10.1371/journal.pone.0305005.s003

S4 File. Financial disclosure statement.

https://doi.org/10.1371/journal.pone.0305005.s004

Acknowledgments

Earlier versions of this article were presented at the 2022 Annual Meeting of Life Course Transitions in East Asia (online) in June 2022, the Annual Meeting of the American Sociological Association, Los Angeles Convention Center, August 2022, the RC20 Regional Conference on Comparative Sociology & the 2nd RC33 Regional Conference on Social Science Methodology: Asia, Japan Women’s University (online), September 2022, and the Society for Longitudinal and Lifecourse Studies International Annual Conference, Case Western Reserve University (online), October 2022. We thank participants of these meetings as well as the editor and reviewers of the journal for their helpful comments. Permission to use the panel data was obtained from the Management Committee of the JLPS. Any remaining errors are the sole responsibility of the authors.

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Chains of tragedy: The impact of bullying victimization on mental health through mediating role of aggressive behavior and perceived social support

1 Institute of Educational Sciences, Hubei University of Education, Wuhan, China

Qiu-jin Zhu

2 School of Philosophy, Wuhan University, Wuhan, China

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Bullying is a worldwide concern for its devastating consequences. The current study focused on bullying victims, examining the effects of being bullied on mental health and the chain of mediating mechanisms among adolescents. Specifically, this study attempts to explain the relationship between bullying victimization and mental health from the perspective of maladaptive behavior and perceived social support.

A total of 3,635 adolescents responded to questions on bullying victimization, aggressive behavior, perceived social support, and mental health measurements including anxiety, depression, and subjective well being scale combined.

(1) Bullying victimization was significantly correlated with aggressive behavior, perceived social support, and mental health, including anxiety, depression, and subjective well being. (2) Bullying victimization not only negatively predicts mental health levels but also has an indirect impact on mental health through three pathways: a separate mediating effect on aggressive behavior, a separate mediating effect on perceived social support, and a chain mediating effect on both.

The present results demonstrate that maladaptive behavior by bullying victims can lead to changes in their perceived social support and mental health problems. Violence begets violence and provides no constructive solutions, instead, produces a tragic chain of victimization. Further implications are discussed accordingly.

Introduction

Bullying victimization is defined as being the target of unwanted aggression and harm in various forms, such as verbal, physical, relational, social bullying, and electronic bullying (Olweus, 1993 ; Sun and Shi, 2017 ). Bullying is a universal phenomenon across different cultures (Chan and Wong, 2015 ; Liu and Lu, 2017 ). Globally, 246 million children reported experiencing bullying and school violence annually (UNESCO, 2019 ). Numerous studies have verified that being bullied has devastating consequences (Peng et al., 2020 ). Those victims of bullying are at an increased risk of low self-confidence, emotional impairment, low level of well being, poor mental health, and even attempts of suicide in both Western and Eastern countries (Cosma et al., 2017 ; Shaheen et al., 2019 ).

Bullying victimization generally leads to a lower level of mental health quality, and this relationship is also influenced by the victims' coping strategy, including the cognition and behavior an individual employs to reduce distress/tension or eliminate stressors (Scarpa and Haden, 2006 ). Previous research has explored bullying victims' coping strategies and the consequences, such as the use of humor, cognitive coping strategies, and help-seeking (Newman et al., 2011 ; Garnefski and Kraaij, 2014 ; Nixon et al., 2020 ; Xie et al., 2022 ). However, previous studies do not adequately consider the multiple coping strategies of bullying victims simultaneously nor examine the underlying relationship among these mechanisms.

According to the general aggression model (GAM), the experience of being bullied as a passive situational factor influences the likelihood of aggressive behavior by exerting influence on aggressive thoughts, angry feelings, and arousal levels, as well as the related appraisal and decision processes. Aggressive action as an outcome influences the social encounter, which usually causes negative social consequences, such as others' responding to the aggression, acting in retaliation, or staying away from the aggressor. At this point, when the individual's reappraisal process is activated, it can influence the present internal state variables (Anderson and Bushman, 2002 ; Allen et al., 2018 ). And the support deterioration model states that stressful events like being bullied deteriorate the perceived availability or the effectiveness of social support, which leads to mental health problems (Barrera, 1986 ). Thus, the current research investigates multiple coping strategies that affect the mental health of bullying victims, and the underlying relationship among these mechanisms. Specifically, this study attempts to examine bullying victims who conduct maladaptive behavior that would lead to a change in their perceived social support and then the level of mental health.

The experience of being bullied harms mental health

Bullying victims are at elevated risk for various externalizing and internalizing problems (Loukas and Pasch, 2013 ). The research found that different forms of bullying (physical, relational, verbal, and cyber) are associated with different harmful behaviors (self-harm, suicide attempts, and suicidal ideation) (Sinclair et al., 2022 ). Being bullied may also result in serious psychological maladjustment and emotional maladaptation. Being the target of bullying leads to the development of hostile attributions and internalizing negative peer messages, and victimization triggers internalized issues in individuals, such as anxiety, depression, low self-esteem, and feelings of loneliness (Loukas and Pasch, 2013 ; Cross et al., 2015 ).

In recent years, researchers started to examine the impact of bullying on individual well being (Varela et al., 2018 ; Miranda et al., 2019 ). A cross-country study of 47,029 children and adolescents in 15 countries found that bullying had a significant negative impact on subjective well being across countries and at different ages (Savahl et al., 2019 ). In China, 636 boarding students of grades 4–6 in rural primary schools were investigated by questionnaire, including school bullying, subjective well being, school bonding, and positive psychological capital, and school bullying was negatively correlated with school bonding and subjective well being (Wu et al., 2022 ).

The dual-factor model of mental health suggests that the concept of a good mental health condition includes the absence of negative indicators (e.g., depression, anxiety, negative affect) and the presence of positive indicators (e.g., subjective well being, life satisfaction, positive affect), which is a more comprehensive and accurate assessment of individual mental health (Greenspoon and Saklofske, 2001 ; Suldo and Shaffer, 2008 ). And based on the above analysis, this study proposes H1 : Bullying victimization negatively predicts mental health levels, including levels of anxiety, depression, and subjective well being.

The impact of bullying victimization on mental health through the mediation effect of maladaptive behavior

Several studies have found victimization increases the risk of maladaptive behavior. Individuals who have suffered from bullying usually have no reasonable way to resolve the accumulation of psychological problems, such as panic, social anxiety, and depression, and this can generate explosive attacks and illegal anti-social behavior (Li, 2016 ; Liu and Lu, 2017 ). The longitudinal research from different cultures also showed that victimization has a long-term negative impact and produces maladaptive reactions. Bullying victims exhibit obstacles in interpersonal communication and produce behavior deviation (Liu and Zhao, 2013 ), and the experience of being bullied could significantly predict aggressive behavior, taking revenge, and getting involved in illegal and violent crimes and violent crimes in adulthood (Jackson et al., 2013 ; DeCamp and Newby, 2015 ).

Maladaptive behavior of bullying victims could produce mental health issues. Bullying victims scored higher on hostile interpretation, anger, retaliation, and ease of aggression than the other children (Camodeca and Goossens, 2005 ), and aggressive acts that would occur as impulsive behavior to cause harm to the source of frustration and defend themselves were positively associated with generalized anxiety symptoms and depressive symptoms (Pederson et al., 2018 ).

The experience of being bullied, maladaptive behavior, and mental health appeared to be closely linked. The bullying victims who engage in aggressive behavior are more likely to attribute hostile intent in ambiguous situations and react more aggressively to peer conflict, which further elicits peer rejection and behavior problems, and are the most maladapted and in greatest need of intervention (Bettencourt et al., 2013 ). Studies have found evidence that depression, anxiety, and loneliness were characteristics of aggressive victims (Shao et al., 2014 ); however, there is also some data which provide no evidence of unique social-emotional dysfunction of aggressive victims. Thus, properly accounting for potentially confounding influences on the internalizing problems is needed (O'Connor et al., 2019 ; O'Connor, 2021 ). The impact of victimization on mental health through maladaptive behavior needs to be examined further. As a result, this study proposes Hypothesis H2 : Bullying victimization can impact mental health levels through the mediating role of aggressive behavior.

The impact of bullying victimization on mental health through perceived social support

Social support is defined as social interactions or relationships that provide individuals with the assistance or support that embed individuals within a social system to provide love, care, or a sense of attachment to a valued social group. And perceived social support is the belief that these helping behaviors will occur when needed (Norris and Kaniasty, 1996 ). If individuals believe they are loved and valued and can depend on others, they are more likely to have help-seeking behavior (Lakey and Cohen, 2000 ).

Perceived social support may be viewed as a variable that has wide-ranging effects on physical and mental well being (Scarpa and Haden, 2006 ). Research reported that adolescents' perceived social support was significantly negatively correlated with suicidal ideation in cyberbullying victimization (Xu et al., 2021 ). The research which explored the perceived social support in crime victims proposed that chronic victimization erodes the victim's perception of social support and in turn, leads to heightened levels of distress and is detrimental to the victim's well being (Yap and Devilly, 2004 ).

Even worse, it has been found that most bullying victims do not actively report these experiences to parents and teachers, and do not seek help in the case of low perceived social support, which creates a vicious cycle of bullying and victimization (Haataja et al., 2016 ; Yablon, 2017 ). The data indicated that only one in four chronically victimized students turned to school staff for help, and 30% of bullying victims kept silent about their problems (Smith and Shu, 2000 ; Sitnik-Warchulska et al., 2021 ).

Thus, understanding the social context in which bullying occurs and the individual's perceived social support in different sources is vital to comprehend both the unique associations between bullying victims and mental health, and facilitate the development of prevention and intervention activities (Noret et al., 2020 ). Based on the above literature, this study proposes Hypothesis H3 : Bullying victimization can impact mental health levels through the mediating role of perceived social support.

The relationship between maladaptive behavior and perceived social support

Evidence suggests that the motivation for aggressive behavior is resorting to control or getting higher social status among peers, but it is the distorted relationship chains (Juvonen and Graham, 2014 ; Sun and Shi, 2017 ). The victim's aggressive behavior could be from mimicking the parents and other adults in the family or social setting (Bandura, 1974 ). Some of them are isolated from social groups during early childhood, forming interpersonal bonds through inappropriate behaviors, such as aggression (Olweus, 1978 ). Published data have identified that bullying victims with aggressive behavior do not share any social benefits with the high social status of bullies, but they have a higher level of distress and peer rejection (Juvonen et al., 2003 ; Chen and Zhang, 2018 ).

Meta-analysis summarizes that bullying victims who engage in aggressive behavior are concurrently associated with a range of adjustment difficulties, including loneliness, school-related fear, anxiety or avoidance, low self-esteem, and fear or avoidance of social interactions (Reijntjes et al., 2010 ). The feeling of neglect in peer relationships may impede their ability to build solid prosocial ties with others and limit their opportunities to gain sufficient social support. For instance, children engaging in bullying perpetration often reported a low quality of parental relationships, which are associated with further psychosocial difficulties in adolescent development (Sitnik-Warchulska et al., 2021 ). Another study in China also found a significantly negative correlation between bullying and perceived social support (Yang, 2020 ). The gradual alienation from peers may also impact bullying victims' mental health, such as anxiety and depression. On this basis, this study proposes Hypothesis H4 : Aggressive behavior and perceived social support play a chain mediating role between bullying victimization and mental health.

Therefore, the current study explores the impact of the experience of being bullied and their maladaptive behavior on mental health and whether perceived social support plays a vital role in the relationship. We investigated the chain mediating effect of bullying victims' aggressive behavior and perceived social support in the relationship between the experience of being bullied and mental health among adolescents. From the adaptation perspective to understand the perplexing role of bullying victims, we try to underline the mechanism of bullying victims' dysfunctional behavior and provide empirical evidence for intervention programs. The relationship path diagram proposed in this study is illustrated in Figure 1 as follows.

Relationship path map of bullying victimization, aggressive behavior, perceived social support, and mental health.

Materials and methods

Participants and procedure.

Eight middle schools were randomly selected in the Hubei province of China. The research ethics committee approved the study at the Hubei University of Education, and it was conducted with the consent of the school and the adolescents' guardians. The students were told that none of their responses would be revealed to anyone and that they could stop participating at any time without penalty. All participants completed an online questionnaire in Chinese. A total of 3,635 valid online questionnaires were obtained. Among students who participated in the survey, 1,757 were male, and 1,878 were female, 968 were studying in grade junior one, 930 were in grade junior two, 583 were in grade junior three, and 547 were in grade senior one, and 607 were in grade senior two. The demographic information of the participants is shown in Table 1 .

Demographic information in the bullying victimization score of adolescents.

Measurements

Bullying victimization.

The bullying victimization is measured by the Olweus Bully/Victimization Questionnaire (OBVQ). The Chinese version of OBVQ which was adopted in current research, was revised with good validity and reliability among adolescents (Xie et al., 2015 ). The OBVQ is comprised of three dimensions namely physical bullying, verbal bullying, and relational bullying. The scale has 12 items. Each item is rated on a six-point Likert scale ranging from 1 (never happened this semester) to 6 (happened every day this semester). The higher score of OBVQ represents a higher degree of victimization experience. In this study, the Cronbach's α value of the questionnaire was 0.93.

Aggressive behavior

The aggressive behavior was measured by a tool to measure aggressive behavior extracted from externalizing problem behavior for adolescents developed by Zhang et al. ( 2011 ). In this study, seven questions were selected and adapted as required, such as “fighting ”, “destroying public property or other people's property for no reason”, “verbally abusing others”, etc., using a five-point Likert scale. The subjects were asked to rate the frequency of the occurrence of these behaviors in the last six months. The mean scores of the seven items were calculated with higher scores indicating more aggressive behavior. Previous studies have shown that the questionnaire has good reliability and validity in the Chinese cultural context (Yu et al., 2011 ). In this study, the Cronbach's α value of the questionnaire was 0.71.

Perceived social support

Zimet et al. ( 1988 ) developed the Multidimensional Scale of Perceived Social Support (MSPSS) to measure the perceived adequacy of social support received from family, friends, and significant others. The MSPSS includes 12 items (e.g., “I can count on my friends when things go wrong”). Respondents report their agreement on a 7-point Likert-type scale with higher total score meaning higher perceived social support. Previous studies showed that the scale had a good reliability and validity when used with Chinese adolescents (Yang and Han, 2021 ). The Cronbach's α value of the Chinese MSPSS used in this study was 0.96.

The Chinese version of the 9-item Patient Health Questionnaire (PHQ-9) was used to measure the severity of depressive symptoms. A total score ranged from 0 to 27 (higher points indicating more severe depressive symptoms), with each item that can earn 0 to 3 points (0 = Not at all to 3 = Nearly every day). Depressive symptoms were classified by severity into five groups, namely, minimal (scores of 0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27) (Kroenke et al., 2001 ). In this study, the average depression score was 3.05, and the standard deviation was 4.56, indicating that the participants' overall depressive symptoms were relatively mild. The Chinese version of PHQ-9 has been widely used, and previous studies showed that the scale had good reliability and validity when used with Chinese adolescents (Leung et al., 2020 ). In this study, the Cronbach's α value of the questionnaire was 0.93.

Anxiety symptoms were measured using the Chinese version of the Generalized Anxiety Disorder scale (GAD-7; Tong et al., 2016 ). Each item has four response options ranging from 0 to 3 (0 = Not at all to 3 = Nearly every day). Each participant can obtain a total score from 0 to 21, with higher score indicating more severe anxiety symptoms. Cut points of 5, 10, and 15 might be interpreted as representing mild, moderate, and severe levels of anxiety on the GAD-7 (Spitzer et al., 2006 ). In this study, the average depression score was 2.98, and the standard deviation was 3.94, indicating that the participants' overall depressive symptoms were relatively mild. The Chinese version of GAD-7 can be used in the Chinese context with good reliability and validity (Zeng et al., 2013 ; Tong et al., 2016 ). This scale had good internal consistency, with a Cronbach's α value of 0.93.

Subjective well being

Subjective well being was measured using the two components: Index of well being and Index of General Affect (Campbell, 1976 ). Ratings for each item in the overall index ranged from 1 to 7. The Index of General Affect consists of eight items that describe the connotation of emotions at different levels, while the Index of well being had only one item. The total score of the Index of Well being and the Index of General Affect was calculated by adding the average scores of its two parts (weight 1.1), with scores ranging from 2.1 to 14.7. In this study, the average subjective well being score was 12.30, and the standard deviation was 3.18.

Common method biases

All measurement items were processed by non-rotational exploratory factor analysis, applying the Harman single-factor test method. Based on the results of the analysis, a total of 3 common factors with eigenvalues greater than 1 were extracted, and the first common factor could be used to explain 38.77% of the total variation, which did not reach the standard threshold of 40%. Thus, this study has no unacceptable deviation caused by the same method for data collection (Podsakoff et al., 2003 ).

Descriptive statistics and correlation coefficients of variables

Table 2 shows the results of descriptive statistics and correlation data of the research variables. Bullying victimization not only shows significant positive correlation with aggressive behavior, depression, and anxiety, but also shows significant negative correlation with perceived social support and subjective well being. Aggressive behavior not only shows a significant positive correlation with depression and anxiety, but also shows a significantly negative correlation with perceived social support and subjective well being. Perceived social support shows a significant positive correlation with subjective well being, and a significant negative correlation with depression and anxiety. Moreover, depression is positively correlated with anxiety, and negatively correlated with subjective well being. Last, anxiety has a significant negative correlation with subjective well being.

Correlation analysis of study variables.

M, Mean; SD. standard deviation.

** P <0.01.

Bullying victimization and mental health: Chain mediating effect test

Chain mediational analysis explored the impact of bullying victimization on mental health through aggressive behavior and perceived social support. Bootstrapping analyses (5,000 re-samples) were conducted for testing the mediational model (Hayes, 2013 ).

The results showed that the total effect (βs = 0.456, 0.434, and −0.336, t s = 29.287, 27.522, and −20.375, All p < 0.001) and the direct effect (βs = 0.318, 0.295, and −0.162, t s = 19.722, 18.041, and −9.822, All p < 0.001) of bullying victimization on depression, anxiety, and subjective well being were all significant. Bullying victimization significantly predicts aggressive behavior (β = 0.264, t = 16.507, p < 0.001), and aggressive behavior significantly predicts depression, anxiety, and subjective well being (βs = 0.118, 0.142, and –.093, t s = 7.992, 9.531, and −6.169, All p < 0.001), indicating that aggressive behavior played a mediating role between bullying victimization and depression, anxiety, and subjective well being separately. Similarly, bullying victimization significantly predicts perceived social support (β = −0.332, t = 20.800, p < 0.001), and perceived social support predicts depression, anxiety, and subjective well being (βs = −0.281, −0.264, and 0.391, t s = −18.452, −17.149, and 25.245, All p < 0.001), indicating that perceived social support played a mediating role between bullying victimization and depression, anxiety, and subjective well being separately. Meanwhile, aggressive behavior can also predict perceived social support (β = −0.110, t = −6.898, p < 0.001). Therefore, aggressive behavior and perceived social support had a chain mediating effect between bullying victimization and depression, anxiety, and subjective well being separately among Chinese teenagers ( Tables 3 – 6 ).

Regression model of the effect of bullying victimization on mental health among Chinese teenagers.

Results of the mediating effect analysis of bullying victimization and depression, anxiety, and subjective well being in Tables 4 – 6 showed that Bootstrap's 95% CI of total indirect effect did not contain 0 [All Bootstrap 95% CI: 0.114, 0.166; 0.115, 0.165; −0.202, −0.149], accounting for 30.26, 32.03, and 51.79% of the total effect. Notably, three indirect effect pathways influenced the relation of bullying victimization and depression, anxiety, and subjective well being. First, the mediating effect values of Path1 (Bullying victimization → Aggressive behavior → Depression, Anxiety, and Subjective well being) were 0.032, 0.039, and −0.026 separately, accounting for 7.02, 8.99, and 7.74% of the total effect. Second, the mediating effect values of Path2 (Bullying victimization → Perceived social support → Depression, Anxiety, and Subjective well being) were 0.097, 0.092, and −0.136 separately, accounting for 21.27, 21.20, and 40.48% of the total effect. Third, the mediating effect values of Path3 (Bullying victimization → Aggressive behavior → Perceived social support → Depression, Anxiety, and Subjective well being) was 0.009, 0.008, and −0.012 separately, accounting for 1.97, 1.84, and 3.57% of the total indirect effect. Note that the chain mediating model is shown in Figures 2A–C .

Mediating effect analysis of bullying victimization and depression.

Mediating effect analysis of bullying victimization and subjective well being.

(A) The mediating effect path map of bullying victimization and depression. * p < 0.05, ** p < 0.01, and *** p < 0.001. (B) The mediating effect path map of bullying victimization and anxiety. * p < 0.05, ** p < 0.01, and *** p < 0.001. (C) The mediating effect path map of bullying victimization and subjective well being. * p < 0.05, ** p < 0.01, and *** p < 0.001.

Mediating effect analysis of bullying victimization and anxiety.

The initial objective of the research was to identify the impact of bullying victimization on mental health, and the serial mediating roles of aggressive behavior and perceived social support among adolescents. As indicated by the results of this study, the experience of being bullied significantly increased the level of mental health issues, such as higher levels of anxiety and depression, and lower levels of subjective well being. The relationship results are consistent with previous studies and verified Hypothesis 1 in the study (Juvonen and Graham, 2014 ).

The present study also discovered that aggressive behavior as a maladaptive reaction had significant mediating effects on the relationship between the experience of being bullied and mental health, with its mediating role accounting for 7.02, 8.99, and 7.74% of the total effect for anxiety, depression, and subjective well being. The Hypothesis 2 is confirmed. In addition, these results verified the negative outcome of aggressive behavior for bullying victims, which demonstrated that bullying victims' crude responses would aggravate the mental health issue. Violence begets violence provides no constructive solutions.

Meanwhile, the current study also found significant mediating effects of perceived social support in the relationship between the experience of being bullied and mental health, with its mediating effect accounting for 21.27, 21.20, and 40.48% of the total effect for anxiety, depression, and subjective well being. The present results are congruent with the latest research in the area of bullying victims and prove Hypothesis 3 (Lin et al., 2020 ). Perceived social support from parents, friends, and other relatives is a vital protective factor to disengage bullying victims from mental health issues.

Previous studies do not adequately consider the multiple coping strategies of bullying victims simultaneously and examine the underlying relationship among these mechanisms. The current study explored the impact of bullying victims' aggressive behavior to perceived social support, and whether aggressive behavior and perceived social support serially mediated the relationship between bullying victimization and mental health. The aggressive behavior of bullying victims may produce feelings of isolation in interpersonal relationships and is harmful for victims' mental health status. The results support Hypothesis 4 that the higher level of bullying victimization would raise the possibility of mental health issues through maladaptive aggressive behavior and lower the level of perceived social support. It has also been confirmed that there is a close correlation between aggressive reaction and perceived social support (Yang, 2020 ). The current study's outcome revealed the basic psychological processes of an individual being bullied and helped us in understanding how their variety of responses led to disastrous outcomes. Teenager bullying victims may adopt simple and rough maladaptive behavior, which aggravate the individual's mental health problems. This process will also weaken the individual's perception of positive resources. This mechanism is a kind of interlocking “Tragic Chain”.

The research revealed the process of how bullying victim's maladaptive coping strategies generates mental health issues through aggressive behavior and perceived social support in a large sample of Chinese adolescents. It is a risk factor for the mental health development of teenagers with the experience of being bullied. That is, the impulsive aggressive behavior of bullying victims would reduce their perceived social support and put their mental health status in danger. It implied that a violent response to violence produces chains of tragedy in bullying situations. Recent research in the related area also discovered the similar phenomenon that forgiving rather than revenge can regain the feeling of humanity after the victimization experience (Schumann and Walton, 2022 ).

Furthermore, the results of the present study support the implementation of bully prevention programs and actions, including: enhancing individual strategies effectively counteract bullying, and increasing empathy toward victims; attaching importance to the social support from peers, school staff, parents, and other stakeholders, guide them to improve assistance afforded to victims, and other relative interventions (Salmivalli et al., 2011 ; Roca-Campos et al., 2021 ). The mediating chain effect of the study sheds light on the underlying processes that the victim's maladaptive behavior would reduce the perceived social support, and then deteriorate mental health. The increasing understanding of these processes supports detailed application to reduce the insensitivity of social resources and mental health problems caused by the experience of being bullied and, through modifying the maladaptive aggressive behavior, alleviates the bullying's negative influence to a certain extent, then breaks the chains of tragedy.

Limitations and future orientation

The current research has some deficiencies and limitations, which may be addressed in the future. First, the present study was a cross-sectional design study, it cannot clarify the causal relationship between variables. Therefore, further research should be conducted to better clarify the relationship between variables through experimental design and longitudinal study. Second, the current research results are in the context of Chinese cultural background. In a collective culture, individuals' survival and development needs depend more on interpersonal relations (Yum, 1988 ). Future studies could explore whether there is a cultural difference in the mechanism of maladaptive reactions of bullying victims.

Bullying and victimization is a growing area of research in psychology. The present study provides further scientific evidence for intervention after the experience of being bullied at the behavioral and cognitive levels. The Chains of Tragedy of bullying victims who conduct maladaptive behavior would lead to a change in their perceived social support and mental health problems, reminding us to draw attention to the sequential effect of multiple variables at work in bully prevention.

Data availability statement

Ethics statement.

The studies involving human participants were reviewed and approved by Ethics Committee of Hubei University of Education. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.

Author contributions

YG: conceptualization, collected the data, writing—review and editing, data curation, and worked on the final version of the manuscript. XT: writing—review and editing, data curation, and worked on the final version of the manuscript. QZ: conceptualization, collected the data, writing—formal analysis, data curation, and worked on the final version of the manuscript. All authors contributed to the article and approved the submitted version.

This work was supported by Ministry of Education of the People's Republic of China Humanities and Social Sciences Youth Foundation under Grant (No. 19YJCZH044).

Conflict of interest

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

Publisher's note

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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Bullying experiences in childhood and health outcomes in adulthood

Affiliation.

• 1 Institute of Social Science, University of Tokyo, Tokyo, Japan.
• PMID: 39008467
• PMCID: PMC11249246
• DOI: 10.1371/journal.pone.0305005

This study examines whether the experience of being bullied at school has a long-term impact on three health outcomes in adulthood in Japan: subjective health, mental health, and activity restriction due to health conditions. We employed a random effects model and the Karlson-Holm-Breen method to decompose the total effect of being bullied at school on health inequality into a direct effect and an indirect effect working through intervening factors including education, marriage, economic well-being, and social networks. We used the Japanese Life Course Panel Surveys 2007-2020 (waves 1-14), a nationally representative panel data set that includes 2,260 male and 2,608 female respondents. The results demonstrate that for both men and women, the direct effect of being bullied at school was strong and significant. Bullying experiences in childhood had a long-term impact on health outcomes in adulthood, regardless of social background and mediating factors of education, marriage, economic well-being, and social networks. Bullying victimization increased the risk of poor subjective health, low mental health scores, and activity restriction due to health conditions. Intervening factors (especially economic well-being and friendship) mediated the association between bullying experiences and all health outcomes, but their contributions were modest. Policy measures not only to prevent bullying during childhood but also to alleviate its negative consequences in adulthood should be considered to help people who have encountered adverse childhood experiences.

Copyright: © 2024 Momose, Ishida. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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The authors have declared that no competing interests exist.

Fig 1. Frequency distribution of subjective health.

Fig 2. Frequency distribution of mental health.

Fig 3. Frequency distribution of activity restriction.

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Survivors of School Bullying: A Collective Case Study

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Bullying: A Case Study Revisited

Cruelty and its impact, years later.

Posted April 9, 2015

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Several years ago, a teacher shared a scenario that exemplified how crafty and insidious bullying can be. I blogged about it at the time and reprinted the story here—as well as a followed up with the young victim:

From the outside, the abuse looked innocuous enough—kids around a table in the cafeteria, singing fragments of popular songs and laughing . Nothing to catch the attention of monitors—until another student bade a young teacher to listen carefully to the lyrics. Muse’s popular song was only tweaked, becoming "Far away / you can’t be far enough away / far away from the people who don’t care if you live or die." Instead of Lady Gaga’s lyrics, the kids chanted “you are so ugly / you are a disease. The boys don’t even want what you’re givin’ for free. No one wants your Love / Ew, yuck, ew / you’re such a joke.” Instead of Beyonce’s, “If you like it then you should’ve put a ring on it,” they sang “you’re a f*#% up and loser put a bag on it.” The repertoire was extensive, and new songs were added every week.

By and large, the students were careful to write lyrics that would pass censorship and not attract attention to themselves for profanity. They delighted in their own cleverness, and in their ability to get many uninvolved bystanders to sing a chorus as they waited in the food line. In other words, the humiliation of one girl became a popular bonding experience, and ad-libbing new lyrics was a way to get positive peer attention.

As they saw it, it was all just a joke. Ha Ha. Can’t she take a little joke?

Recently, I tracked down the victim (she is at a top-tier college) and she agreed to reflect on her experiences. I first asked whether she remembered the correct lyrics to those songs, all these years later. My mistake. I assumed the alternate lyrics were seared into her brain. Instead, she told me she had forgotten the revised songs, and would not have recalled the lyrics had I not transcribed them, years ago. When I asked whether she had ever gotten an apology , or if one would change anything now, she didn’t think there was any need.

Gratifying as it was to see her doing well, these were not the responses I anticipated. But as parents and educators think about bullying, it is important to keep in mind that not all incidents—not even all ongoing cruelties that clearly affect a young adult—will scar her for life. And that we may, at times, do a disservice to young people by rushing in to fix what we perceive as threatening, undermining their own abilities to handle it.

Our inability to gauge resilience is complicated by the fact that much cruelty lies in intersubjective nuances that are equally impossible to grasp, let alone gauge. However, much of the capacity for reparation lies in those nuances as well.

To my mind, singing cruelly revised songs (and encouraging others to sing along) was ongoing abuse, one that called for an intervention. However, "loud singing on the bus" was the only concrete issue that was ever addressed. The victim herself refused any involvement of school authorities, and—as she appears to be thriving—it seems this was the "right call" on her part. (Was it that she could not quite define herself as a victim? That she was handling her "victimization" in ways that adults could not see? That the teacher saw to it that ringleaders got in trouble for unrelated offenses? That—appearances to the contrary—she is burdened by insecurity and secret shame ?)

Interviewing this young woman prompted me to track down, and reconsider, something Clive Seale wrote almost two decades ago:

“in the ebb and flow of everyday interactions, as has been conveyed so effectively in the work of [Erving] Goffman, there exist numerous opportunities for small psychic losses, exclusions and humiliations, alternating with moments of repair and optimism . [Thomas] Scheff (1990) has sought to understand this quality of everyday interaction as consisting of cycles of shame and pride as the social bond is alternately damaged and repaired. The experience of loss and repair is, then, a daily event. In this sense “ bereavement ” (and recovery from it) describes the continual daily acknowledgement of the problem of human embodiment.” (1998)

To adults looking on, cruel song lyrics certainly seem a large "ebb" in the flow of this young student’s life—one requiring intervention. Her story, however, reminds us that as we forge ahead, looking for ways to protect our children against bullying, we must simultaneously enable them to negotiate the "ebbs" in life. A first step in this may simply involve helping them identify the "flow." This is not to lessen active response to bullying, or to sweep it under the rug, but to teach our children to challenge the negative self-narratives that form around bullying experiences. And—perhaps more importantly—to teach them that as bystanders, they contribute to the narratives of others (either implicitly or explicitly). At the risk of sounding Pollyannaish, the identification of counter-factual evidence may go far in challenging this negativity. It turns out, this is precisely what this young women was able to—though a group of friends outside the school environment, who not only raised awareness of, but contributed to, her flow.

Laura Martocci, Ph.D . is a Social Psychologist known for her work on bullying and shame. A former faculty member and dean at Wagner College, her current work centers around identity (re)construction and the transformative potential in change.

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A case study of bullying: Ex-Freeman High School student says peer harassed him for years; alleged bully denies it

Dana Condrey’s son didn’t want to leave his high school, especially not because of a bully.

But in September, the 16-year-old junior transferred to Ferris High School, after what the family describes as years of being taunted and beat up by a fellow Freeman High School student.

“It just got to the point where (he) just said, ‘I’m done. I want out,’ ” Condrey said.

The bullying started in the fifth grade. Five years later, in June 2015, Condrey’s son was thrown to the ground during gym class at Freeman by a fellow student. The fall blackened his eye and burst his eardrum, according to a police record of the incident.

Both boys were freshmen and the violence was captured on video and investigated by police. No charges were filed.

That was the most egregious and visible act in a long string of harassment and intimidation, according to the boy and his parents.

They obtained an anti-harassment order from a judge in October 2015 after a hearing where testimony and documents were submitted.

However, the boy accused of the harassment and his parents have been fighting back. Their attorney, Julie Watts, found the order troubling. So far those efforts, including a February ruling by the Washington State Court of Appeals, have failed.

“Anti-harassment orders have criminal penalties if they are violated, even accidentally, and having one on your record can prevent you from getting future employment or future housing,” Watts said in an email in response to questions about the case.

For instance, Watts said the order allows a kid to “sit down at the restrained kid’s lunch table so that he has to leave or can’t eat with his friends without being charged with a crime.”

However, Condrey, the mother of the boy thrown to the ground, said this is not a valid concern, since her son transferred to Ferris in September.

Robert Cossey, the attorney for Condrey and her son, said the family didn’t want to go to court, and tried multiple times to resolve the issue informally.

“It was the last resort,” Cossey said. “My clients didn’t have a lot of money. They didn’t want to hire me. They didn’t want to go through this process.”

In court documents, the boy who claims he was bullied wrote that he’d asked teachers and administrators to put a stop to the harassment numerous times.

“I have tried to do the right thing for many years but it hasn’t made it stop,” he wrote in a statement to the court.

The accused bully and his family claim the two teenagers were friends and that the incident in the gym was “simply an accident.”

“I have never physically threatened him or harmed him,” the boy stated in written testimony to the court.

His father is a member of the Freeman School Board and hired a private investigator to probe the claims against his son.

According to the private investigator’s interview with staff and students, no one witnessed the alleged bullying and harassment prior to the gym incident. Several of the alleged bully’s football teammates also wrote letters in support of him.

However, an email exchange from 2011 documents an incident in which the alleged bully shoved the other child into a garbage can.

In that email, sent to a school staff member, the bullied boy’s father writes, “We can deal with a little childish play amongst boys … but we are really concerned that one day the pushing on ice into a garbage can is going to result in him hitting his head, (or) him getting really hurt by getting punched in the lower back.”

The alleged victim’s family claimed they tried multiple times to resolve the issues informally. However, the alleged bully’s family said they received no such communications, according to court documents.

In 2013, Condrey, the alleged victim’s mother, sent an email to a Freeman staff member claiming her son had “been punched, tripped, kicked, wrestled to the ground in the parking lot, spit on, pulled out of his chair, and hit in the head with a book bag” by the alleged bully.

That email was subsequently forwarded to the alleged bully’s father’s official Freeman School District email address, according to court documents.

The protection order allows the alleged bully to graduate from Freeman. However, he must stay 20 feet away from the alleged victim and may not speak to him.

In the appeals, the alleged bully challenged the validity of the anti-harassment order, claiming there wasn’t sufficient evidence, that the investigation wasn’t sufficient and that the incident in the gym was not indicative of a pattern.

Watts argued the anti-harassment order is not intended to be used to resolve what state code calls “schoolyard scuffles.”

However, the appellate judges upheld the October 2015 decision, claiming that by virtue of the police investigating the gym incident it had become more than a school yard scuffle.

“From these facts, it was reasonable for the trial court to conclude that (he) would likely resume harassment … as he had before, if the order did not extend through the end of high school,” the appellate court wrote.

Condrey said her son is shocked at the difference in school cultures between Ferris and Freeman.

“It was normal, it was part of the day,” she said of bullying. “And now he’s at Ferris and he never sees any of that, it’s not tolerated.”

Editors note: This story has been updated to include a correction that the case was not tried by a jury.

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Bullying case studies

The following case studies provide examples of workplace bullying, its impact on an individual’s health and safety and examples of how employers failed to control the risk.

Workplace bullying is repeated, unreasonable behaviour directed at an employee or group of employees that creates a risk to health and safety.

Bullying of one employee

M started his first job as an apprentice plumber at the age of 16. Two years into his apprenticeship, M made a complaint to WorkSafe about his experiences at work, which included:

• his boss calling him gay and using offensive language towards him
• his boss encouraging other employees to call him names, ask inappropriate questions and make crude insinuations about his personal life
• his boss taking his mobile phone and making him believe he had posted inappropriate comments on a female friend's page
• having a live mouse put down the back of his shirt by another employee
• having his work shorts ripped up by his boss
• having liquid nails squirted into his hair and face by fellow employees
• being beaten with plumbing pipes and having hose connectors thrown at him by his boss and fellow employees
• being spat on by employees
• having a rag doused with methylated spirits held over his mouth by his boss

The impact on M's physical and mental health

For a long time, M felt too afraid of losing his job to complain to his boss about the treatment he was subjected to. However, he eventually became distressed to the point that he was afraid to go to work. He began experiencing nightmares, insomnia, difficulty concentrating, getting angry for no reason, tearfulness, depression, anxiety and stress.

M was eventually diagnosed with a psychological disorder which prevented him from being able to return to work with his employer.

Risk to health and safety

The bullying behaviour that M was subjected to at work impacted his health and safety and resulted in both physical and psychological injury. The employer failed to control that risk as it did not have a bullying policy, and did not provide proper supervision, information, instruction and training to its employees on workplace bullying.

Prosecution outcome

The employer in the actual case was found guilty of offences under the Occupational Health and Safety Act 2004, and was convicted and fined $12,500.

Bullying of multiple employees

S, m, l and j's story.

S, M, L and J were part of a group of employees at a commercial bakery where they were required to perform tasks including baking, sandwich preparation, general food preparation, cleaning and delivery of orders to local businesses.

They alleged they had been subjected to verbal, physical and emotional abuse by their employer over a period of two years. The abuse included:

• being called 'pig', 'porky', 'dog' and other derogatory names by their boss
• being sworn at, with their boss using foul and abusive language
• their boss yelling and grunting at them for no apparent reason
• having items such as sticks thrown at them or at their desks
• their boss threatening them with physical harm, including being attacked by dogs and being dissolved in acid
• having trolleys pushed into the backs of their legs
• being labelled as 'useless' and 'a waste of space' by their boss
• being told by their boss to 'go away and die, and make sure you die quietly'

The impact on the victims' physical and mental health

One of the women reported that as a result of the bullying, she had 'lost my friends, my life, my world and my mind'. Others reported that they suffered mental and physical distress, including depression and exacerbation of other psychological conditions. Some went on to suffer relationship breakdowns.

The treatment S, M, L and J and their colleagues were subjected to at work created a risk to their health and safety and resulted in them suffering both physical and psychological injuries. The employer had no systems or procedures in place to regulate that workplace behaviour and no policies or procedures to educate employees in respect of appropriate workplace behaviour and workplace bullying.

The employer in the actual case was found guilty of offences under the Occupational Health and Safety Act 2004, and was convicted and fined $50,000.

Bullying of an employee by a manager

S is a teacher in the private sector and has 20 years of experience at the school. The school was going through a change management process. S made an application to the Fair Work Commission for an Order to Stop Bullying based on allegation which included:

• The principal, M, allocating a business manager to conduct S's annual review despite the fact that the business manager had not conducted any other teacher's review, had no educational experience and had recently had unpleasant exchanges with S.
• M entered a discussion between S and the pay clerk about S's long service leave request and, standing very close to S with clenched fists, said 'I have not signed off on it. You have to wait.' M was not actually dealing with the leave application.
• On S's return from long service leave, S was directed to complete an induction program for new employees and was appointed a mentor with less experience than she had. S was the only employee to have to do the induction on return from leave and the only employee who was not new to be allocated a mentor.

The impact on S's physical and mental health

As a result of the behaviours, S felt isolated, targeted and demeaned in the workplace. S was also insulted, embarrassed and humiliated by being allocated a mentor and having to do the induction training in spite of her 20 years' experience. S felt so distressed because of the personal behaviour of the principal towards her that S saw her doctor and was given time off work.

The treatment S was subjected to at work impacted on her health and safety and resulted in her suffering a psychological injury. The employer could have prevented this from occurring by:

• ensuring the appropriate person conducted the annual review
• training managers in how to interact professionally with employees
• providing appropriate training to employees based on their experience in the job

Bullying of one employee by multiple colleagues

K was a police officer and was successful in being promoted into a new team. K made a common law claim for damages alleging she suffered injuries as a result of her employer's negligence. The behaviours that led to K suffering a mental injury allegedly included:

• being given the worst desk normally reserved for temporary staff
• being told that her supervisor thought she had slept with the boss to get the job
• after announcing she was pregnant, the supervisor asked her if she had slept with the boss to get the job
• the supervisor calling HR in front of her and asking if she could be replaced because she was pregnant
• the supervisor told K that the only way he could get rid of her was if she voluntarily relinquished the job and asked if she was willing to do so
• being called 'the black widow' by the supervisor when she walked into the room.
• being socially ostracised by the team
• having difficulty getting time off to look after her child post maternity leave when other people had no trouble getting time off to play golf
• not being invited on a social club interstate trip
• being shouted at when she questioned being left out of the social club interstate trip

The impact on K's physical and mental health

K went from being a fit and healthy young woman to being unable to work and suffering from depression, high anxiety and panic attacks.

The treatment that K was subjected to at work impacted on her health and safety and resulted in her suffering a psychological injury. The employer could have prevented this from occurring by:

• ensuring that appropriate supervision was provided under Section 21(2)(e) of the Occupational Health and Safety Act 2004
• providing appropriate training to its managers on how to handle maternity leave arrangements and post-maternity leave return to work
• providing appropriate training to all employees about acceptable workplace behaviour

Employer duties

The Occupational Health and Safety Act 2004 (OHS Act) requires employers to eliminate risks to health and safety, so far as reasonably practicable. If it is not reasonably practicable to eliminate risks, the employer must reduce risks, so far as reasonably practicable.

The best approach to deal with risks to health and safety associated with workplace bullying is to implement appropriate measures in the workplace.

In line with their duty to eliminate and reduce risks to health, including psychological health, employers have a responsibility to identify hazards and assess associated risks that may lead to workplace bullying. As an employer, you must control any associated risks, review and, if necessary, revise risk control measures.

Related pages

This information is from 'Workplace bullying: A guide for employers'. The complete guide is available in two formats.

Website version PDF guide

Related information

Worksafe victoria.

A grieving mom’s TikTok videos spark online speech battle

Judge orders Mississippi woman to take down posts accusing schoolmates of bullying her daughter to death.

A judge has ordered a Mississippi woman who says her daughter was bullied to death to shut down her social media accounts, as a small-town tragedy balloons into an online drama with millions of onlookers.

After 13-year-old Aubreigh Wyatt died by suicide in September 2023, her grieving mother, Heather Wyatt, began posting about her death on TikTok, attracting hundreds of thousands of followers. Heather Wyatt attributed her daughter’s death to bullying, both online and offline , at the hands of schoolmates in Ocean Springs, Miss., near Biloxi.

Though Wyatt didn’t name the four teens she accused of bullying her daughter, their names and other information about them quickly surfaced in the replies to her posts, as well as in other TikTok and Facebook posts by her followers and supporters. Now the families of those four teens say they’re the ones being subjected to a vicious campaign of harassment and threats, and they’ve sued Wyatt for defamation and slander.

The saga is playing out online before an audience that reaches far beyond the 20,000 residents of Ocean Springs, illustrating how TikTok can put a national spotlight on a local tragedy in ways that complicate the lives of those involved. The case pits a grief-stricken mother’s right to speak out against the privacy and safety of the teens she blames for her daughter’s death.

On July 1, a judge in Jackson County Chancery Court granted an emergency injunction requiring Wyatt to temporarily shut down her TikTok, Facebook and other social media accounts “to protect the minor children in this case.” The order was leaked and circulated widely online despite the court ordering all records sealed, as earlier reported by the Biloxi Sun-Herald.

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Outraged supporters of Wyatt have posted TikTok videos protesting her “silencing,” some of which have been viewed hundreds of thousands of times. The judge is scheduled to review the order in a hearing next week.

That case is separate from the defamation lawsuit against Wyatt, which the four teens’ families filed on July 2 in the county’s circuit court. They say Wyatt in her TikTok videos invited her followers to learn and reveal the names of the four teens, even after investigations by local police and a youth court found no evidence that they were responsible for Aubreigh Wyatt’s death.

In one particularly emotional video, Wyatt showed herself stumbling on her daughter’s suicide notes to members of the family months after her death. The family had previously thought Aubreigh didn’t leave a note.

Some TikTok videos about the case, which often include hashtags such as #LLAW (for Live like Aubreigh Wyatt), have millions of likes and tens of millions of views on the platform.

Wyatt has started a GoFundMe for her legal expenses, bringing in more than $95,000 from nearly 4,000 donors as of Wednesday afternoon. She did not respond to requests for comment Wednesday, and an attorney representing her declined to comment.

Wyatt has said in TikTok videos that her goal is to shine a light on teen mental health issues . The plaintiffs accuse her of trying to capitalize on the situation for “clicks,” to grow her social media following and bring in revenue.

Patrick Guild, the plaintiffs’ attorney, said he couldn’t comment on the judge’s order because the case was sealed by court order, adding that he was disappointed to see it posted on social media.

“What has happened as a result of that is that a lot of different theories, and I’ll say, false information has come out” as to the reasons for the order, Guild said. He added that the accusations of bullying by his clients are “patently false” but have been “elevated to such a grand scale based on Heather Wyatt’s number of followers.”

“As a result, my clients have been receiving threats that in my opinion can be construed as real concerns for their safety,” he said.

Razzan Nakhlawi contributed to this report.

If you or someone you know needs help, visit 988lifeline.org or call or text the Suicide & Crisis Lifeline at 988.

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Workplace bullying in developing countries is wearing women down

17 July 2024

Workplace bullying against women in Pakistan is driving emotional exhaustion and job dissatisfaction among female workers, new research reveals.

A University of South Australia study reveals that workplace bullying is significantly undermining job productivity and hindering economic development in Pakistan, where women are seen as subordinates.

More than 300 female workers in Pakistan’s education and health sectors were surveyed on gendered workplace bullying.

Findings from in-depth interviews revealed women had experienced various bullying behaviours against them including verbal, emotional, social, and physical/sexual bullying, such as casual teasing, insults, taking away of responsibilities, devaluation of work and social isolation.

Women are disproportionately affected by workplace bullying, with 30% globally experiencing it (WHO 2021), costing up to four percent of GDP in less-developed nations (World Bank 2022).

Pakistan’s workforce is predominantly male (83%) with female participation decreasing from 24% to 22% between 2016 and 2022 (World Bank, 2022).

Associate Professor Connie Zheng from UniSA’s Centre for Workplace Excellence , says male-dominated cultures, such as Pakistani society, influence the level of tolerance towards bullying.

“Workplace bullying is normalised in Pakistani society and occurs in casual conversation or for the amusement of others,” she says.

“We heard that often bystanders joined in, perpetuating the behaviour, and the affected women felt angry and weak. It was also evident that women were often seen as sexual objects and played submissive roles in the workplace.”

One participant shared her experience of sexual bullying from their male supervisor who was “not just touching but also asking me for a relationship and calling me in his office and using the inappropriate comments”.

Others told of their experiences with male colleagues acting aggressively out of frustration and jealousy when challenged by their female counterparts. “They can’t see a woman rising… so they try to break that woman by verbally assaulting or pressurising them”.

Assoc Prof Zheng says the findings of the study, which was conducted in collaboration with the Riphah International University and the National University of Modern Languages in Pakistan, identified a high tolerance towards bullying.

“In male dominated cultures, working women often face pressure from their family and society if they encounter workplace issues. Victims are blamed, leading them to stay silent instead of speaking up,” she says.

“On the other hand, many working women fear repercussions like being fired if they speak up against bullying. So, they endure the bullying and mistreatment to sustain their family’s livelihood. Tolerance is also displayed by the organisations and institutions themselves, perpetuating the silence.

Assoc Prof Zheng says a surprisingly positive aspect was identified among some Pakistani working women. Instead of being beaten down by the bullying, they were driven by it to perform better.

“Despite facing humiliation, women performed well in the workplace, reflecting a double-edged sword. Bullying can spur female workers to exceed expectations because they’re potentially driven by a desire to prove themselves,” she says.

“Yet, there are long-term mental health implications from excessive job demands. Someone can only operate in a highly stressed environment for so long.”

The study reveals systemic gender biases favouring men and exposes the need for real changes to address gender disparities and protect female workers from bullying.

Assoc Prof Zheng says organisations that provide social opportunities such as activities and informal gatherings can help foster cohesion and highlight workplace issues. Social support networks in workplaces can also provide women with a safe space to speak up when facing bullying.

“Addressing bullying is not only a responsibility for organisations, but it’s also as much to do with individual empowerment,” she says. “Women who experience workplace bullying should be empowered to stay confident and be strong enough to confront bullies. Silence is not an option.”

END. ………………………………………………………

Media contact: Melissa Keogh, Communications Officer, UniSA M: +61 403 659 154 E: [email protected]

Researcher contact: Associate Professor in Human Resource Management, researcher from UniSA’s Centre of Workplace Excellence, Connie Zheng, UniSA E: [email protected]

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