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Aims--To examine the association of direct (e.g. hitting) and relational (e.g. hurtful manipulation of peer relationships) bullying experience with common health problems.
Methods--A total of 1639 children (aged 6-9 years) in 31 primary schools were studied in a cross sectional study that assessed bullying with a structured child interview and common health problems using parent reports. Main outcome measures were common physical (e.g. colds/coughs) and psychosomatic (e.g. night waking) health problems and school absenteeism.
Results--Of the children studied, 4.3% were found to be direct bullies, 10.2% bully/victims (i.e. both bully and become victims), and 39.8% victims. Direct bully/victims, victims, and girls were most likely to have physical health symptoms (e.g. repeated sore throats, colds, and coughs). Direct bully/victims, direct victims, and year 2 children were most likely to have high psychosomatic health problems (e.g. poor appetite, worries about going to school). Pure bullies (who never got victimised) had the least physical or psychosomatic health problems. No association between relational bullying and health problems was found.
Conclusions--Direct bullying (e.g. hitting) has only low to moderate associations with common health problems in primary school children. Nevertheless, health professionals seeing children with repeated sore throat, colds, breathing problems, nausea, poor appetite, or school worries should consider bullying as contributory factor.
(Arch Dis Child 2001;85:197-201)
Keywords: bullying; health problem; primary school
Approximately 8-46% of children [1-4] experience being bullied in primary school. Adverse effects of peer victimisation on psychological maladjustment such as anxiety, depressive feelings, low self esteem, or loneliness have been found in studies of predominantly secondary school children. [5-7] In contrast, there is a dearth of research on the relation of bullying experiences and common health complaints  and school absenteeism. Williams et al found that 9-10 year olds who reported common health problems such as tummy aches or sleeping problems also reported being victims of bullying two to four times more frequently.  However, as the informants on bullying and health problems were the children, often in the presence of their parents, the effects may have been inflated.  There may be a tendency for victims to exaggerate adverse effects.  Recent research indicates that a proportion of victims are also bullies at other times (bully/victims [2,4,9]) and have been reported to differ significantly fro m "pure" bullies in their behaviour. [10-12] They should be considered separately from pure victims or pure bullies. Finally, little is known about the adverse effects of more subtle forms of victimisation on common health complaints involving the hurtful manipulation of peer relationships and friendships, often called relational bullying [4,13,14] to direct bullying comprising physical (hitting) or direct verbal (threats) aggression.
We investigated the association of bullying involvement among 6-9 year old primary school children, assessed with a structured private interview by postgraduate psychologists, to parent reports of common health complaints and school records of school absenteeism.
Participants and methods
All 2201 children and their parents in 78 classes in 31 primary schools were approached for consent. For 107 children (5.4%) parents declined permission and a further 112 (5.7%) were not present on the days of interviewing. Total participation rate for the interviews was thus 88.9% (n = 1982). The age ranged from 6 to 9 years with an average age of 7.6 (SD 1.0) years (year 2: 6.7 (SD 0.6) years; year 4: 8.3 (SD 0.6) years). A total of 51.4% were male and 49.6% female; 8.9% of children were from ethnic minorities.
Ethical approval for the study was granted by the University of Hertfordshire Ethical Committee.
Children were individually interviewed between 1996 and 1998 using …