Virtual learning intervention to reduce bullying victimization in primary school: a controlled trial

Antibullying Interventions in Schools: Assessing the Evidence Base

OBJECTIVE

This systematic review used established rating criteria to describe the level of evidence for interventions aimed at preventing or reducing bullying perpetration and victimization in schools, synthesized the evidence for students from racially and ethnically diverse backgrounds, and reviewed the literature for available information to conduct an economic analysis of the interventions.

METHODS

Major databases, gray literature, and evidence-base registries were searched to identify studies published from 2008 through 2022. The authors rated antibullying intervention models as having high, moderate, or low evidence depending on the number and rigor of studies with positive findings.

RESULTS

Overall, 80 articles reporting on 71 original research studies describing a total of 48 antibullying interventions met the inclusion criteria for this review. Two schoolwide interventions received a high-evidence rating: the KiVa (Kiusaamista Vastaan) Antibullying Program and the Friendly Schools program. Multilevel interventions with components at the levels of school, classroom, and individual student most consistently showed strong evidence for reducing bullying behavior in elementary and middle school grades. Four interventions yielded positive effects in reducing bullying and victimization among diverse samples of students.

CONCLUSIONS

Antibullying interventions can reduce bullying in schools. Some interventions show effectiveness with students from racially and ethnically diverse backgrounds. The gains relative to per-student costs were in the range that is considered cost-effective. Most implementation costs are spent on staff training and support. Research on successful implementation of whole-school interventions and additional synthesis of evidence pertaining to program structures would further advance the antibullying evidence base.

Developing a virtual reality environment for educational and therapeutic application to investigate psychological reactivity to bullying

Understanding how bullying victimisation influences cognitive and emotional processes may help to direct early intervention to prevent the development of psychopathology. In a convenience sample of 67 female adolescents, we assessed the potential of a newly developed classroom-set bullying experience in virtual reality (VR) to evoke psychological reactions. Two VR experiences were co-developed with young people, one neutral and one hostile (bullying). Participants were matched and assigned to a condition based on measures of anxiety, depression, paranoia, and previous bullying, before experiencing either the neutral or hostile scenario. Before and after the VR session, participants completed measures of negative affect and levels of distress. All participants remained immersed for the whole duration, which supports the acceptability of using these VR experiences with more vulnerable participants. Those experiencing the hostile version reported greater negative affect post-immersion compared to those experiencing the neutral version (p = .018; d = 0.61). Although non-significant, a similar outcome was found regarding distress (p = .071; d = 0.37). Whilst we did not find a significant relationship between pre-existing internalisation on negative affect and distress, our sample was limited by containing adolescents with relatively low levels of previous bullying experience. Yet we still found evidence that the VR scenario evoked bullying-related psychological reactions. Further testing with a more representative groups of adolescents, especially those with more experience of bullying, would be advised. The VR scenario could potentially be used in educational and therapeutic settings to enhance empathy towards victimised children or enhance resilience following victimisation.

Effectiveness of Digital Health Interventions in Reducing Bullying and Cyberbullying: A Meta-Analysis

Bullying and cyberbullying bring adverse physical and psychological impacts on individuals and an economic burden for society. Scholars have developed anti-bullying intervention programs to combat these problems. This meta-analysis aims to examine and compare the effectiveness of digital health interventions (DHIs) in reducing bullying and cyberbullying. A comprehensive search was conducted using databases (PsycINFO, Social Service Abstracts, Sociological Abstracts, MEDLINE, ERIC, and EMBASE). Quasi-experimental and randomized controlled trials (RCTs) published before 31 January 2021 that reported the effects of DHIs in reducing bullying or cyberbullying were included. The 16 studies included in the synthesis reported overall random effect sizes (Cohen's d) for bullying and cyberbullying reduction were 0.41 and 0.19, respectively. The results provide evidence on the effectiveness of DHIs, comparable to that of face-to-face interventions. The subgroup analysis revealed that the critical components of effective DHIs include training on bystander and bully-victim dual roles, coping skills, and interactive serious games. It highlights the promising effects of digital health approaches in bullying and cyberbullying interventions. Our review identifies avenues for future research on the development of more effective DHIs to reduce bullying and cyberbullying.

Emotional Intelligence and School Bullying Victimization in Children and Youth Students: A Meta-Analysis

School victimization among children and youth is a global public health issue that has long-term adverse effects on the victims' mental health and behavioral development. Theories and research suggest that emotional intelligence may operate as a buffer against school bullying victimization. However, the strength of the association between emotional intelligence and bullying victimization is controversial. Therefore, we aimed to conduct a meta-analysis to evaluate the exact association between Emotional intelligence and school bullying victimization. We conducted a systematic search in PubMed, Web of Science, ProQuest Dissertations, Google Scholar, and China National Knowledge Infrastructure (CNKI) from inception to March 2022 for relevant studies that examine the association between emotional intelligence and school bullying victimization without a language limit. Twenty-four articles were included in our meta-analysis (n = 27,438). There was a small, negative, and significant association between emotional intelligence and school victimization among children and youth students. Sex and emotional intelligence measurement tools were variables that significantly moderated the link between emotional intelligence and bullying victimization. The findings indicated that improving students' emotional intelligence could be a crucial strategy to lower the students' risk of being bullied in school and online. It would be more effective among male students.

Effectiveness of school-based programs to reduce bullying perpetration and victimization: An updated systematic review and meta-analysis

Background

Bullying first emerged as an important topic of research in the 1980s in Norway (Olweus), and a recent meta-analysis shows that these forms of aggression remain prevalent among young people globally (Modecki et al.). Prominent researchers in the field have defined bullying as any aggressive behavior that incorporates three key elements, namely: (1) an intention to harm, (2) repetitive in nature, and (3) a clear power imbalance between perpetrator and victim (Centers for Disease Control and Prevention; Farrington). There are many negative outcomes associated with bullying perpetration, such as: suicidal ideation (Holt et al.), weapon carrying (Valdebenito et al.), drug use (Ttofi et al.), and violence and offending in later life (Ttofi et al.). Bullying victimization too is associated with negative outcomes such as: suicidal ideation (Holt et al.), anxiety, low self-esteem and loneliness (Hawker& Boulton). Therefore, school bullying is an important target for effective intervention, and should be considered a matter of public health concern.

Objectives

The objective of this review is to establish whether or not existing school-based antibullying programs are effective in reducing school-bullyng behaviors. This report also updates a previous meta-analysis conducted by Farrington and Ttofi. This earlier review found that antibullying programs are effective in reducing bullying perpetration and victimization and a primary objective of the current report is to update the earlier analysis of 53 evaluations by conducting new searches for evaluations conducted and published since 2009.

Search Methods

Systematic searches were conducted using Boolean combinations of the following keywords: bully*; victim*; bully-victim; school; intervention; prevention; program*; evaluation; effect*; and anti-bullying. Searches were conducted on several online databases including, Web of Science, PscyhINFO, EMBASE, EMBASE, DARE, ERIC, Google Scholar, and Scopus. Databases of unpublished reports, such as masters' and doctoral theses (e.g., Proquest) were also searched.

Selection Criteria

Results from systematic searches were screened thoroughly against the following inclusion criteria. To be included in this review, a study must have: (1) described an evaluation of a school-based antibullying program implemented with school-age participants; (2) utilized an operational definition of school-bullying that coincides with existing definitions; (3) measured school-bullying perpetration and/or victimization using quantitative measures, such as, self-, peer-, or teacher-report questionnaires; and (4) used an experimental or quasi-experimental design, with one group receiving the intervention and another not receiving the intervention.

Data Collection and Analysis

Of the 19,877 search results, 474 were retained for further screening. The majority of these were excluded, and after multiple waves of screening, 100 evaluations were included in our meta-analysis. A total of 103 independent effect sizes were estimated and each effect size was corrected for the impact of including clusters in evaluation designs. Included evaluations were conducted using both randomized (n = 45; i.e., randomized controlled trials/RCTs) and nonrandomized (n = 44; i.e., quasi-experimental designs with before/after measures; BA/EC) methodologies. All of these studies included measures of bullying outcomes before and after implementation of an intervention. The remaining 14 effect sizes were estimated from evaluations that used age cohort designs. Two models of meta-analysis are used to report results in our report. All mean effects computed are presented using both the multivariance adjustment model (MVA) and random effects model (RE). The MVA model assigns weights to primary studies in direct proportion to study level sampling error as with the fixed effects model but adjusts the meta-analytic standard error and confidence intervals for study heterogeneity. The RE model incorporates between-study heterogeneity into the formula for assigning weights to primary studies. The differences and strengths/limitations of both approaches are discussed in the context of the present data.

Results

Our meta-analysis identified that bullying programs significantly reduce bullying perpetration (RE: odds ratio [OR] = 1.309; 95% confidence interval [CI]: 1.24-1.38; z = 9.88; p < .001) and bullying victimization (RE: OR = 1.244; 95% CI: 1.19-1.31; z = 8.92; p < .001), under a random effects model of meta-analysis. Mean effects were similar across both models of meta-analysis for bullying perpetration (i.e., MVA: OR = 1,324; 95% CI: 1.27-1.38; z = 13.4; p < .001) and bullying victimization (i.e., MVA: OR = 1.248; 95% CI: 1.21-1.29; z = 12.06; p < .001). Under both computational models, primary studies were more effective in reducing bullying perpetration than victimization overall. Effect sizes varied across studies, with significant heterogeneity between studies for both bullying perpetration (Q = 323.392; df = 85; p < .001; I 2  = 73.716) and bullying victimization (Q = 387.255; df = 87; p < .001; I 2  = 77.534) outcomes. Analyses suggest that publication bias is unlikely. Between-study heterogeneity was expected, given the large number of studies included, and thus, the number of different programs, methods, measures and samples used.

Authors' Conclusions

We conclude that overall, school-based antibullying programs are effective in reducing bullying perpetration and bullying victimization, although effect sizes are modest. The impact of evaluation methodology on effect size appears to be weak and does not adequately explain the significant heterogeneity between primary studies. Moreover, the issue of the under-/over-estimation of the true treatment effect by different experimental designs and use of self-reported measures is reviewed. The potential explanations for this are discussed, along with recommendations for future primary evaluations. Avenues for future research are discussed, including the need further explain differences across programs by correlating individual effect sizes with varying program components and varying methodological elements available across these 100 evaluations. Initial findings in the variability of effect sizes across different methodological moderators provide some understanding on the issue of heterogeneity, but future analyses based on further moderator variables are needed.

Efficacy of Cyberbullying Prevention on Somatic Symptoms-Randomized Controlled Trial Applying a Reasoned Action Approach

The theory of reasoned action (ToRA) has been proposed as a framework for cyberbullying prevention design, targeting attitudes and norms. In this study effects of a long (10 weekly sessions) and a short (one day, four sessions) cyberbullying prevention program based on the ToRA were compared with a control group over 9 months. Longitudinal data from 722 students (mean age = 13.36) on cyberbullying, somatic symptoms, attitudes, and norms were analyzed within a structural equation model. Participation in the long intervention group significantly reduced cyberbullying (d = -0.584) and somatic symptoms (d = -0.316). No between-group differences emerged for attitudes and norms. Developmental trajectories and associations were found to be as suggested by ToRA in both cross-sectional and change-score analyses.

Understanding Alternative Bullying Perspectives Through Research Engagement With Young People

Bullying research has traditionally been dominated by largescale cohort studies focusing on the personality traits of bullies and victims. These studies focus on bullying prevalence, risk and protective factors, and negative outcomes. A limitation of this approach is that it does not explain why bullying happens. Qualitative research can help shed light on these factors. This paper discusses the findings from four mainly qualitative research projects including a systematic review and three empirical studies involving young people to various degrees within the research process as respondents, co-researchers and commissioners of research. Much quantitative research suggests that young people are a homogenous group and through the use of surveys and other large scale methods, generalizations can be drawn about how bullying is understood and how it can be dealt with. Findings from the studies presented in this paper, add to our understanding that young people appear particularly concerned about the role of wider contextual and relational factors in deciding if bullying has happened. These studies underscore the relational aspects of definitions of bullying and, how the dynamics of young people's friendships can shift what is understood as bullying or not. Moreover, to appreciate the relational and social contexts underpinning bullying behaviors, adults and young people need to work together on bullying agendas and engage with multiple definitions, effects and forms of support. Qualitative methodologies, in particular participatory research opens up the complexities of young lives and enables these insights to come to the fore. Through this approach, effective supports can be designed based on what young people want and need rather than those interpreted as supportive through adult understanding.

Why Does a Universal Anti-Bullying Program Not Help All Children? Explaining Persistent Victimization During an Intervention

Although anti-bullying interventions are often effective, some children continue to be victimized. To increase knowledge of potential factors that might impede children's benefiting from an anti-bullying intervention, we examined potential reasons for individual differences in victimization trajectories during a group-based anti-bullying intervention. Data stem from a five-wave survey among 9122 children (7-12 years old; grades 2-5) who participated in the KiVa anti-bullying intervention (n = 6142) or were in control schools (n = 2980 children). Three trajectories were found in the intervention sample, representing children who experienced stable high, decreasing, or stable low/no victimization. A two-trajectory model of high and low trajectories represented the control sample best. Multinomial regressions on the intervention sample showed that children who experienced particularly high levels of peer rejection, internalizing problems, and lower quality parent-child relationships decreased less in victimization; thus these characteristics appeared to contribute to persistent victimization. The results call for tailored strategies in interventions aiming to reduce victimization for more children.

Social skills interventions for survivors of pediatric brain tumors: A review and reformulation

Youth with brain tumors are at risk for late effects. Families report that survivors' difficulties with peer relationships are among the most distressing and impactful on quality of life. As such, interventions have been designed to improve social functioning. The objective was to review the nine published social skills intervention studies for survivors of brain tumors with regard to study design, participation rates, skills targeted, assessment measures, and outcomes. Results of this review were used to discuss future directions, with a focus on alternative approaches to inclusion criteria (including developmental considerations and screening for weaknesses), intervention timing and modality.

Walking in a Patient's Shoes: An Evaluation Study of Immersive Learning Using a Digital Training Intervention

Objectives: Evidence suggests that immersive learning increases empathy and understanding of the patient experience of illness. This study evaluated a digital training intervention 'In Their Shoes' which immerses participants in the experience of living with inflammatory bowel disease (IBD), highlighting the biopsychosocial impact. The simulation program uses a mobile application to deliver time-based tasks and challenges over 36 h, supplemented with telephone role-play and 'kit' items to open and use. This study investigated changes in IBD understanding and connection to patients, empathy and perception of job value in a group of pharmaceutical employees. Additionally, it explored experiences and impact of taking part in the intervention. Methods: A mixed methods pre-post design was utilized, with an opportunity sample of employees taking part in the training. 104 participants from sites in 12 countries completed measures at baseline and 97 post-intervention. Measures included the Toronto Empathy Questionnaire, Prosocial Job Characteristics Scale, and structured questions around IBD understanding and connection to patients. Two focus groups (N = 14) were conducted regarding participants experiences of the intervention to complement an open-response question in the questionnaire (N = 75). Qualitative data was analyzed using thematic analysis. Results: Following the intervention, there were statistically significant increases in IBD understanding and connection to patients (p < 0.00025), evaluation of organizational innovation (p < 0.00025), empathy (d = 0.45) and prosocial job perceptions (d = 0.28). Qualitative analysis revealed more fully the transformative personal journey undertaken by participants which provided 'eye opening' insight into the psychosocial impact of living and working with IBD. This insight encouraged patient perspective-taking and a strong desire to promote patient advocacy and reduce stigma around chronic illness. Finally, greater organizational pride and connectivity was evident for some participants. Conclusions: An immersive training program, focussing on the lived experience of illness, led to significant increases in disease understanding and empathy. These findings align with other literature evaluating immersive learning and the potential for increasing knowledge, empathy and motivation. The present study offers opportunities to extend this outside of the body of work focussing on healthcare practitioners and explores the benefits of using this type of learning experience within an organizational setting.

Empathy in Virtual Agents and Robots

This article surveys the area of computational empathy, analysing different ways by which artificial agents can simulate and trigger empathy in their interactions with humans. Empathic agents can be seen as agents that have the capacity to place themselves into the position of a user’s or another agent’s emotional situation and respond appropriately. We also survey artificial agents that, by their design and behaviour, can lead users to respond emotionally as if they were experiencing the agent’s situation. In the course of this survey, we present the research conducted to date on empathic agents in light of the principles and mechanisms of empathy found in humans. We end by discussing some of the main challenges that this exciting area will be facing in the future.

System to Detect Racial-Based Bullying through Gamification

Prevention and detection of bullying due to racial stigma was studied in school contexts using a system designed following "gamification" principles and integrating less usual elements, such as social interaction, augmented reality and cell phones in educational scenarios. "Grounded Theory" and "User Centered Design" were employed to explore coexistence inside and outside the classroom in terms of preferences and distrust in several areas of action and social frameworks of activity, and to direct the development of a cell phone app for early detection of school bullying scenarios. One hundred and fifty-one interviews were given at five schools selected for their high multiracial percentage and conflict. The most outstanding results were structural, that is the distribution of the classroom group by type of activity and subject being dealt with. Furthermore, in groups over 12 years of age, the relational structures in the classroom in the digital settings in which they participated with their cell phones did not reoccur, because face-to-face and virtual interaction between students with the supervision and involvement of the teacher combined to detect bullying caused by racial discrimination.

Is Participatory Design Associated with the Effectiveness of Serious Digital Games for Healthy Lifestyle Promotion? A Meta-Analysis

Background

Serious digital games can be effective at changing healthy lifestyles, but large differences in their effectiveness exist. The extent of user involvement in game design may contribute to game effectiveness by creating a better fit with user preferences. Participatory design (PD), which represents active user involvement as informant (ie, users are asked for input and feedback) or codesigner (ie, users as equal partners in the design) early on and throughout the game development, may be associated with higher game effectiveness, as opposed to no user involvement or limited user involvement.

Objective

This paper reports the results of a meta-analysis examining the moderating role of PD in the effectiveness of serious digital games for healthy lifestyle promotion.

Methods

Four databases were searched for peer-reviewed papers in English that were published or in press before October 2014, using a (group-) randomized controlled trial design. Effectiveness data were derived from another meta-analysis assessing the role of behavior change techniques and game features in serious game effectiveness.

Results

A total of 58 games evaluated in 61 studies were included. As previously reported, serious digital games had positive effects on healthy lifestyles and their determinants. Unexpectedly, PD (g=0.075, 95% CI 0.017 to 0.133) throughout game development was related to lower game effectiveness on behavior (Q=6.74, P<.05) than when users were only involved as testers (g=0.520, 95% CI 0.150 to 0.890, P<.01). Games developed with PD (g=0.171, 95% CI 0.061 to 0.281, P<.01) were also related to lower game effectiveness on self-efficacy (Q=7.83, P<.05) than when users were not involved in game design (g=0.384, 95% CI 0.283 to 0.485, P<.001). Some differences were noted depending on age group, publication year of the study, and on the specific role in PD (ie, informant or codesigner), and depending on the game design element. Games developed with PD were more effective in changing behavioral determinants when they included users in design elements on game dynamics (beta=.215, 95% CI .075 to .356, P<.01) and, more specifically, as an informant (beta=.235, 95% CI .079 to .329, P<.01). Involving users as informants in PD to create game levels was also related to higher game effectiveness (Q=7.02, P<.01). Codesign was related to higher effectiveness when used to create the game challenge (Q=11.23, P<.01), but to lower game effectiveness when used to create characters (Q=4.36, P<.05) and the game world (Q=3.99, P<.05).

Conclusions

The findings do not support higher effectiveness of games developed with PD. However, significant differences existed among PD games. More support was found for informant roles than for codesign roles. When PD was applied to game dynamics, levels, and game challenge, this was associated with higher effectiveness than when it was applied to game aesthetics. Since user involvement may have an important influence on reach, adoption, and implementation of the intervention, further research and design efforts are needed to enhance effectiveness of serious games developed with PD.

Impact of Cyberprogram 2.0 on Different Types of School Violence and Aggressiveness

Some antibullying interventions have shown positive outcomes with regard to reducing violence. The aim of the study was to experimentally assess the effects on school violence and aggressiveness of a program to prevent and reduce cyberbullying. The sample was comprised of a randomly selected sample of 176 adolescents (93 experimental, 83 control), aged 13–15 years. The study used a repeated measures pre-posttest design with a control group. Before and after the program, two assessment instruments were administered: the “Cuestionario de Violencia Escolar-Revisado” (CUVE-R [School Violence Questionnaire – Revised]; Álvarez-García et al., 2011) and the “Cuestionario de agresividad premeditada e impulsiva” (CAPI-A [Premeditated and Impulsive Aggressiveness Questionnaire]; Andreu, 2010). The intervention consisted of 19 one-hour sessions carried out during the school term. The program contains 25 activities with the following objectives: (1) to identify and conceptualize bullying/cyberbullying; (2) to analyze the consequences of bullying/cyberbullying, promoting participants’ capacity to report such actions when they are discovered; (3) to develop coping strategies to prevent and reduce bullying/cyberbullying; and (4) to achieve other transversal goals, such as developing positive variables (empathy, active listening, social skills, constructive conflict resolution, etc.). The pre-posttest ANCOVAs confirmed that the program stimulated a decrease in: (1) diverse types of school violence—teachers’ violence toward students (ridiculing or publicly humiliating students in front of the class, etc.); students’ physical violence (fights, blows, shoves… aimed at the victim, or at his or her property, etc.); students’ verbal violence (using offensive language, cruel, embarrassing, or insulting words… toward classmates and teachers); social exclusion (rejection or exclusion of a person or group, etc.), and violence through Information and Communication Technologies (ICT; violent behaviors by means of electronic instruments such as mobile phones and the Internet)—; and (2) premeditated and impulsive aggressiveness. Pre-posttest MANCOVA revealed differences between conditions with a medium effect size. This work contributes an efficacious intervention tool for the prevention and reduction of peer violence. The conclusions drawn from this study have interesting implications for educational and clinical intervention.

Bullying victimisation and paranoid ideation in people at ultra high risk for psychosis

BACKGROUND

Bullying victimisation has been suggested to contribute to paranoid ideation in general population samples and recent evidence found that individuals with an ultra high risk (UHR) for psychosis are twice as likely to have been bullied than controls.

AIMS

This study sought to examine whether a history of bullying would be associated with higher levels of paranoid ideation in individuals with an UHR and in healthy controls (HCs).

METHOD

The study included 64 UHR and 43 HC participants. Following the baseline assessment, participants entered a Virtual Reality (VR) London Underground train. Paranoid ideation was measured immediately after the end of the VR experience.

RESULTS

Compared to HCs, UHR participants described higher levels of childhood bullying (OR 5.19, 95% CI=2.21-12.19, p<.001) and experienced more paranoid ideation during VR (χ(2)(1)=21.06, p<.001). Childhood bullying was associated with paranoid ideation during VR in both groups (χ(2)(1)=5.931, p=,021) but prolonged exposure to bullying was not associated with increased paranoid ideation.

CONCLUSION

A history of bullying in childhood is particularly common in young adults at high risk for psychosis. However bullying is associated with paranoid ideation in later life, independent of clinical status, consistent with dimensional models of psychotic phenomena.

Bullying of preterm children and emotional problems at school age: cross-culturally invariant effects

OBJECTIVE

To investigate whether adolescents who were born extremely preterm (<26 weeks gestation), very preterm (<32 weeks gestation), or with very low birth weight (<1500 g) are more often bullied, and whether this contributes to higher emotional problem scores.

STUDY DESIGN

We used 2 whole population samples: the German Bavarian Longitudinal Study (BLS) (287 very preterm/very low birth weight and 293 term comparison children) and the UK EPICure Study (183 extremely preterm and 102 term comparison children). Peer bullying was assessed by parent report in both cohorts at school years 2 and 6/7. The primary outcome was emotional problems in year 6/7. The effects of prematurity and bullying on emotional problems were investigated with regression analysis and controlled for sex, socioeconomic status, disability, and preexisting emotional problems.

RESULTS

Preterm-born children were more often bullied in both cohorts than term comparisons (BLS: relative risk, 1.27; 95% CI, 1.07-1.50; EPICure: relative risk, 1.69; 95% CI, 1.19-2.41). Both preterm birth and being bullied predicted emotional problems, but after controlling for confounders, only being bullied at both ages remained a significant predictor of emotional problem scores in both cohorts (BLS: B, 0.78; 95% CI, 0.28-1.27; P < .01; EPICure: B, 1.55; 95% CI, 0.79-2.30; P < .001). In the EPICure sample, being born preterm and being bullied at just a single time point also predicted emotional problems.

CONCLUSION

Preterm-born children are more vulnerable to being bullied by peers. Those children who experience bullying over years are more likely to develop emotional problems. Health professionals should routinely ask about peer relationships.

A meta-analysis of the effect of school-based anti-bullying programs

Bullying is a serious public health problem, and many studies have examined the effect of school-based anti-bullying programs. However, these programs and those outcomes are complex, broad, and diverse. Research is needed into the optimal strategies for these comprehensive programs, which consider both the effectiveness and cost of programs. We performed a meta-analysis of 13 studies using the Comprehensive Meta-Analysis software package to calculate effect size (ES) and the Q statistic. We conducted subgroup analyses to examine the differences based on student grade level, program duration, and program strategy. The pooled ES calculation indicated that school-based anti-bullying programs have a small to moderate effect on victimization. The results of the Q test indicated significant heterogeneity across studies of victimization (Q = 39.625; I (2) = 69.7%; p < .001). Studies involving training in emotional control (p < .01), peer counseling (p < .05), or the establishment of a school policy on bullying (p < .05) showed significantly larger ESs on victimization than did studies that did not involve these strategies. Effective school-based anti-bullying programs should include training in emotional control, peer counseling, and the establishment of a school policy on bullying.

Bullying in medically fragile youth: a review of risks, protective factors, and recommendations for medical providers

Bullying is a common child and adolescent phenomenon that has concurrent and long-term implications for victims' psychological, psychosomatic, social, and academic functioning. Youth with chronic illnesses are at increased risk for being bullied, but few studies have evaluated specific risk and protective factors for medically fragile youth. Despite recommendations by the American Academy of Pediatrics and the Society for Adolescent Medicine that pediatric health care providers should contribute to bullying prevention and intervention efforts, researchers also have yet to identify the best ways for providers to intervene with medically fragile youth. In this article, the authors review risk and protective factors for bullying among healthy samples. Then, the authors specifically address the ways in which these risk and protective factors are likely to apply to children with fragile medical conditions, and they provide summaries of extant bullying research for selected examples of medically fragile pediatric populations. Finally, the authors present recommendations for intervening with medically fragile youth and suggest several areas in which additional research is needed.

A meta-analysis of serious digital games for healthy lifestyle promotion

Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies for healthy lifestyle promotion, in which we investigated the overall effectiveness of serious digital games on healthy lifestyle promotion outcomes and the role of theoretically and clinically important moderators. Findings showed that serious games have small positive effects on healthy lifestyles (g=0.260, 95% CI 0.148; 0.373) and their determinants (g=0.334, 95% CI 0.260; 0.407), especially for knowledge. Effects on clinical outcomes were significant, but much smaller (g=0.079, 95% CI 0.038; 0.120). Long-term effects were maintained for all outcomes except for behavior. Serious games are best individually tailored to both socio-demographic and change need information, and benefit from a strong focus on game theories or a dual theoretical foundation in both behavioral prediction and game theories. They can be effective either as a stand-alone or multi-component programs, and appeal to populations regardless of age and gender. Given that effects of games remain heterogeneous, further explorations of which game features create larger effects are needed.

Bullying and parasomnias: a longitudinal cohort study

BACKGROUND AND OBJECTIVES

Environmental factors such as serious trauma or abuse and related stress can lead to nightmares or night terrors. Being bullied can be very distressing for children, and victims display long-term social, psychological, and health consequences. Unknown is whether being bullied by peers may increase the risk for experiencing parasomnias such as nightmares, night terrors, or sleepwalking.

METHODS

A total of 6796 children of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort were interviewed at elementary school age (8 and 10 years) about bullying experiences with a previously validated bullying interview and at secondary school age (12.9 years) about parasomnias such as nightmares, night terrors and sleepwalking by trained postgraduate psychologists.

RESULTS

Even after adjusting for pre-existing factors related to bullying and parasomnias, being bullied predicted having nightmares (8 years odds ratio [OR], 1.23; 95% confidence interval [CI], 1.05-1.44; 10 years OR, 1.62; 95% CI, 1.35-1.94) or night terrors (8 years OR, 1.39; 95% CI, 1.10-1.75; 10 years OR, 1.53; 95% CI, 1.18-1.98) at age 12 to 13 years. Especially being a chronic victim was associated with both nightmares (OR, 1.82; 95% CI, 1.46-2.27) and night terrors (OR, 2.01; 95% CI, 1.48-2.74). Being a bully/victim also increased the risk for any parasomnia at ages 8 or 10 years (8 years OR, 1.42; 95% CI, 1.08-1.88; 10 years OR, 1.75; 95% CI, 1.30-2.36). In contrast, bullies had no increased risk for any parasomnias.

CONCLUSIONS

Being bullied increases the risk for having parasomnias. Hence, parents, teachers, school counselors, and clinicians may consider asking about bullying experiences if a child is having parasomnias.

Involvement in bullying and suicide-related behavior at 11 years: a prospective birth cohort study

OBJECTIVE

To study the prospective link between involvement in bullying (bully, victim, bully/victim), and subsequent suicide ideation and suicidal/self-injurious behavior, in preadolescent children in the United Kingdom.

METHOD

A total of 6,043 children in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort were assessed to ascertain involvement in bullying between 4 and 10 years and suicide related behavior at 11.7 years.

RESULTS

Peer victimization (victim, bully/victim) was significantly associated with suicide ideation and suicidal/self-injurious behavior after adjusting for confounders. Bully/victims were at heightened risk for suicide ideation (odds ratio [OR]; 95% confidence interval [CI]): child report at 8 years (OR = 2.84; CI = 1.81-4.45); child report at 10 years (OR = 3.20; CI = 2.07-4.95); mother report (OR = 2.71; CI = 1.81-4.05); teacher report (OR = 2.79; CI = 1.62-4.81), as were chronic victims: child report (OR = 3.26; CI = 2.24-4.75); mother report (OR = 2.49; CI = 1.64-3.79); teacher report (OR = 5.99; CI = 2.79-12.88). Similarly, bully/victims were at heightened risk for suicidal/self-injurious behavior: child report at 8 years (OR = 2.67; CI = 1.66-4.29); child report at 10 years (OR = 3.34; CI = 2.17-5.15); mother report (OR = 2.09; CI = CI = 1.36-3.20); teacher report (OR = 2.44, CI = 1.39-4.30); as were chronic victims: child report (OR = 4.10; CI = 2.76-6.08); mother report (OR = 1.91; 1.22-2.99); teacher report (OR = 3.26; CI = 1.38-7.68). Pure bullies had increased risk of suicide ideation according to child report at age 8 years (OR = 3.60; CI = 1.46-8.84), suicidal/self-injurious behavior according to child report at age 8 years (OR = 3.02; CI = 1.14-8.02), and teacher report (OR = 1.84; CI = 1.09-3.10).

CONCLUSIONS

Children involved in bullying, in any role, and especially bully/victims and chronic victims, are at increased risk for suicide ideation and suicidal/self-injurious behavior in preadolescence.

Why interventions to reduce bullying and violence in schools may (or may not) succeed: Comments on this Special Section

The research area around aggression and violence in schools, and especially that on school bullying, has grown enormously in the last 30 years. There are good grounds for concern about these issues, given the negative effects of school bullying on mental health and in the more extreme cases, links to suicides. Intervention and prevention programs have grown since their origins in the 1980s, and are now quite varied and international. Recent meta-analyses suggest that on average, antibullying campaigns have had some modest success; but there is still much to understand about why programs vary in effectiveness, and much to learn about making prevention and intervention efforts more successful in the future. The five papers in this Special Section contribute to our knowledge in this respect. They are discussed in relation to some key issues, including: the nature of both prevention and intervention programs, school policies and implementation issues, importance of teacher training, extent of national support for school-based interventions, and sustainability of effects.

Diagnostic efficiency of several methods of identifying socially rejected children and effect of participation rate on classification accuracy

Social rejection is associated with a wide variety of negative outcomes. Early identification of social rejection and intervention to minimize its negative impact is thus important. However, sociometric methods, which are considered high in validity for identifying socially rejected children, are frequently not used because of (a) procedural challenges, (b) community apprehension, and (c) sensitivity to missing data. In a sample of 316 students in grades K through 8, we used receiver operating characteristics (ROC) analyses to compare the diagnostic efficiency of several methods for identifying socially rejected children. When not using least-liked nominations, (a) most-liked nominations yielded the greatest diagnostic efficiency (AUC=.96), (b) peer ratings were more efficient (AUC=.84 to .99) than teacher ratings (AUC=.74 to .81), and (c) teacher report of social status was more efficient (AUC=.81) than scores from teacher behavior rating scales (AUC=.74 to .75). We also examined the effects of nominator non-participation on diagnostic efficiency. At participation as low as 50%, classification of sociometric rejection (i.e., being rejected or not rejected) was quite accurate (κ=.63 to .77). In contrast, at participation as high as 70%, classification of sociometric status (i.e., popular, average, unclassified, neglected, controversial, or rejected) was significantly less accurate (κ=.50 to .59).

Longitudinal associations among peer victimization and physical and mental health problems

OBJECTIVE

This study examined how chronic experiences of peer victimization throughout childhood relate to mental and physical health outcomes in adolescence.

METHODS

Children were tested in a laboratory playroom at the age of 5 years. They completed questionnaires at time 2, between the ages of 10 and 18 years, and a telephone interview at time 3, between the ages of 12 and 20 years. A total of 70 youth participated at all three time periods. Chronic victims were defined as having high levels of peer victimization at all three time points.

RESULTS

Youth who were chronically victimized reported experiencing significantly more mental and physical health problems than youth categorized as desisters or nonvictims. Also, for girls only, chronic victims reported more specific health problems (headaches, sleep problems) than did nonchronic victims.

CONCLUSIONS

The present findings may assist health professionals in assessing and treating physical and mental health problems that appear to be related to peer victimization.

Individual and social network predictors of the short-term stability of bullying victimization in the United Kingdom and Germany

BACKGROUND

There is still relatively little research on the social context within which bullying develops and remains stable.

AIM

This study examined the short-term stability of bullying victimization among primary school students in the United Kingdom and Germany (mean age, 8.9 years) and the individual and social network factors that contributed to remaining a victim of bullying.

SAMPLE

The sample consisted of 454 children (247 males and 207 females).

METHODS

Participants completed questionnaires on bullying victimization at three assessment points over a 9-week period. Other measures consisted of self-reported demographic, peer, and family relationship characteristics. Social network indices of density, reciprocity, and hierarchy were constructed using friendship and peer acceptance nominations.

RESULTS

Relative risk analyses indicated a six-fold increased risk of remaining a victim at consequent follow-ups, compared to a child not victimized at baseline becoming a victim over the follow-up period. Individual characteristics explained substantially more variance in the stability of bullying victimization than class-level factors. Hierarchical logistic regression analyses revealed that being victimized by siblings and being rejected by peers predicted remaining a victim over a 9-week period.

CONCLUSIONS

Bullying victimization among primary school students proved moderately stable over a 9-week period. Individual characteristics were more influential in predicting the stable victim role than class-level factors. Our findings have implications for the identification of stable victims in primary school and early preventative bullying programs.