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Pediatrics

Published: Sep 17, 2013

Action Points

Victims of schoolyard bullying faced an approximately doubled risk of physical health problems compared with nonbullied children followed for up to 11 years, a meta-analysis indicated.

Pooled data from six longitudinal studies involving 3,911 children yielded an odds ratio of 2.39 (95% CI 1.76-3.24, P<0.0001) for complaints such as headache, disordered sleep, and abdominal pain in those who reported being bullied at school compared with those not reporting bullying, according to Gianluca Gini, PhD, and Tiziana Pozzoli, PhD, of the University of Padua in Italy.

Findings from another 24 cross-sectional studies were similar, with an odds ratio for physical symptoms of 2.17 (95% CI 1.91-2.46, P<0.0001) in pooled data on a total of more than 200,000 children, Gini and Pozzoli reported online in Pediatrics.

The findings were not especially surprising, since all the individual studies included in the meta-analysis had found higher rates of health complaints in bullied versus nonbullied children; in nearly all of them, the differences were statistically significant.

Gini and Pozzoli did not report absolute incidences of symptoms among bullied versus nonbullied children in the pooled data. However, one of the larger longitudinal studies included in the meta-analysis, conducted in the Netherlands and published in Pediatrics in 2006 by Minne Fekkes, MSc, PhD, and colleagues, found such symptoms in 5% to 22% of children who reported bullying versus 1% to 12% of nonbullied children (P<0.05 for six of seven symptoms).

"This meta-analysis significantly complements the growing body of research that documents the poor personal adjustment of bullied children and adolescents, in terms of both internalizing and externalizing problems," wrote Gini and Pozzoli, who regarded the symptoms reported in the included studies as psychosomatic.

They recommended that pediatricians consider bullying as a risk factor for such complaints for headache, respiratory and eating problems, and insomnia, and that these symptoms, in turn, may signal that a child is being bullied.

"Any recurrent and unexplained somatic symptom can be a warning sign of bullying victimization," the researchers asserted. Physicians should also review these potential signals of bullying with parents, because children are often reluctant to talk openly about bullying episodes.

For the study, Gini and Pozzoli searched the published literature for longitudinal and cross-sectional studies that reported incidences of physical symptoms (other than traumatic injuries) in children who reported bullying or no bullying. Ascertainment of bullying and health symptoms came from children's voluntary self-report, interviews with children, or reports by parents or teachers. Studies had to provide effect sizes and confidence intervals to be included in the meta-analysis, or enough detail to allow Gini and Pozzoli to calculate them.

Of 119 potentially eligible studies, 30 met the authors' inclusion criteria. Sample sizes in the six longitudinal studies ranged from 65 to 1,806. The 24 cross-sectional studies ranged in sample size from 291 to 123,227. Study sites included the U.S., China, India, Mexico, Turkey, and many nations in western Europe. Most of the larger studies either involved whole populations or cluster random sampling. Follow-up in the longitudinal studies ranged from 9 months to 11 years.

Gini and Pozzoli found that the gender distribution of study participants was significantly associated with the risk of psychosomatic symptoms. Specifically, as the percentage of girls in the study sample increased, the magnitude of the association between bullying and physical symptoms decreased (B=-0.04, 95% CI -0.07-minus 0.02, P<0.002).

Studies' geographic location and their methods of measuring bullying did not affect the meta-analysis results, the authors indicated.

Limitations to the analysis included typical drawbacks to meta-analyses such as the potential to have missed studies that might have warranted inclusion, erroneous data in the included studies, and publication bias. Also, many of the included studies were based on child self-report of bullying and physical symptoms, which may have over- or underestimated the true incidences.

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