The healthy context paradox: a cross-country analysis of the association between bullying victimisation and adolescent mental health

Bullying victimisation is an increasing global health problem among adolescents and is associated with short- and long-term adverse mental health outcomes. Investigating whether associations with mental health vary across national contexts and why, can provide insights into mechanisms underlying those associations and inform policy. We used data from 479,685 adolescents participating in the 2018 Program for International Student Assessment (PISA) cross-sectional survey and examined whether the associations between bullying victimisation, psychological distress and life satisfaction vary across 63 countries. We further tested the modifying role of country-level factors - bullying prevalence, income inequality and national wealth, by implementing multilevel cross-country analyses. We found significant associations between bullying victimisation, increased psychological distress (β = 0.181; 95%CI: 0.178, 0.184) and decreased life satisfaction (β = -0.158; 95%CI: -0.162, -0.155). Associations between bullying victimisation, psychological distress and life satisfaction among adolescents were consistent across countries in terms of direction but effect sizes varied substantially. The effects ranged from β = 0.08 in the Philippines to β = 0.40 in South Korea for psychological distress and from β = -0.05 in the Philippines to β = -0.36 in the United Kingdom for life satisfaction. In addition, consistent with the "healthy context paradox" effect, associations between bullying and mental health were larger in countries where the prevalence of bullying was lower, as well as in higher-income countries. Interventions aiming to reduce bullying victimisation should aim to provide additional targeted support for those who still experience bullying after the intervention.

The health context paradox in the relationship between victimization, classroom bullying attitudes, and adolescent depression: An analysis based on the hlm model

From the perspective of the health context paradox, this study examined the relationship between adolescent victimization and depression based on the diathesis-stress model and attribution theory using a nested model. A survey was conducted on 3743 Chinese adolescents using the Bullying & Victimization Scale, Rumination Scale, Beck Depression Inventory, and Bullying Attitude Scale. The results disclosed that victimization had a positive impact on depression, rumination played a mediating role between victimization and depression, and classroom anti-bullying attitudes heightened the correlation between victimization and developing depression as well as between victimization and engaging in rumination thinking. This study provides a new cross-level perspective to reduce the occurrence of depression among bullied adolescents and further validates the health context paradox, expanding its applicability range. It also provides new experimental research references for reducing depression among bullied adolescents from a more comprehensive, cross-level perspective in the future.

The Healthy Context Paradox Between Bullying and Emotional Adaptation: A Moderated Mediating Effect

Introduction

Bullying is a significant concern for young people, with studies consistently showing a link between bullying and negative emotional consequences. However, the mechanisms that underlie this association remain unclear, particularly in terms of the classroom environment. This study aimed to explore the paradoxical phenomenon between bullying victimization and emotional adaptation among junior high school students in China, using the hypothesis of the healthy context paradox.

Methods

The study involved 880 students (565 girls; Mage=14.69; SD=1.407 years), and data were collected using self-reported surveys. The findings of the study, utilizing multilevel structural equation modeling (MSEM) techniques, demonstrated a cross-level moderated effect of classroom-level bullying victimization on the relationship between individual bullying victimization and emotional adaptation.

Results

Specifically, the results indicated that in classrooms with higher levels of victimization, the association between individual bullying victimization and increased depressive symptoms and State&Trait anxiety was more pronounced. These findings support the "Healthy context paradox" hypothesis in the Chinese context and provide insight into the mechanisms underlying this phenomenon.

Discussion

The results suggest that the classroom environment plays a crucial role in shaping the emotional consequences of bullying and that addressing classroom victimization is crucial for promoting emotional health among young people. By understanding the mechanisms that underlie the association between bullying and emotional consequences, interventions can be developed to target the underlying factors that contribute to this paradoxical phenomenon. Overall, the study provides new insights into the complex relationship between bullying and emotional health among young people, highlighting the importance of considering the classroom environment in addressing this issue.

Moderators of the Link Between Social Preference and Persistent Peer Victimization for Elementary School Children

OBJECTIVE

Current antibullying programs can reduce overall rates of victimization but appear to overlook processes that give rise to persistent peer victimization. Needed are studies that delineate the interplay between social contextual and individual difference variables that contribute to persistent peer victimization. We examined the extent to which two individual-difference variables - internalizing symptoms (IS) and anxiety sensitivity (AS) - moderated the link between children's average social preference score across the school year and their status as persistent victims.

METHOD

Participants included 659 4th-grade students (Mage = 9.31 years, SD = 0.50, 51.8% girls; 42.3% Latinx, 28.9% non-Hispanic White, 10.2% Pacific Islander, 7.7% Bi/Multiracial, 1.9% Black, 1.7% Asian, 1.7% Native American, and 3.4% unreported) from 10 public elementary schools in the U.S.

RESULTS

As expected, higher social preference scores predicted a decreased likelihood of being persistently victimized. Conversely, IS and AS were positively linked to persistent victim status. AS significantly moderated the link between social preference and persistent victim status such that for children with high AS, compared to those with AS scores at or below the mean, the negative association between social preference and persistent victim status was attenuated.

CONCLUSIONS

Findings provide evidence that children who experience high levels of IS and AS are at risk for being persistently victimized by peers and that high AS could signal increased risk for persistent victimization even when children are generally liked by peers. We discuss the implications of these findings for efforts to develop focused interventions for chronically bullied children.

Students' School and Psychological Adjustment in Classrooms with Positive and Negative Leaders

Positive and negative leadership styles may influence classroom norms and be related to the school and psychological adjustment of children in general, and victims in particular. This study tested the relation between leadership styles and children's adjustment, and the moderating effects of leadership on the association between self-reported victimization and school and psychological adjustment (self-esteem, social anxiety, and depressive symptoms); and it tested for potential gender differences. Classrooms were classified into those with only positive leaders, only negative leaders, both positive and negative leaders, and without leaders. The sample contained 8748 children (Mage = 10.05, SD = 1.22; 51.2% girls) from 392 classrooms, in grades three to six, in 98 Dutch schools. Multilevel analysis revealed that, in general, children in negative leader classrooms experienced lower school well-being than children in other classrooms. In positive leader classrooms, male and female victims had lower school well-being. For psychological well-being, female victims had lower self-esteem and more depressive symptoms in positive leader classrooms. Male and female victims in negative leader classrooms did not suffer from additional maladjustment. These results demonstrate that negative leadership styles are related to lower school well-being of all children, whereas victimization in classrooms with positive leaders is negatively related to male and female victims' school well-being and girls' psychological adjustment (depressive symptoms); this is in line with the 'healthy context paradox'.

Is there really a healthy context paradox for victims of bullying? A longitudinal test of bidirectional within-and between-person associations between victimization and psychological problems

The finding that victims' psychological problems tend to be exacerbated in lower-victimization classrooms has been referred to as the "healthy context paradox." The current study has put the healthy context paradox to a strict test by examining whether classroom-level victimization moderates bidirectional within- and between-person associations between victimization and psychological adjustment. Across one school year, 3,470 Finnish 4th to 9th graders (Mage = 13.16, 46.1% boys) reported their victimization, depressive symptoms, anxiety, and self-esteem. Three types of multilevel models (cross-lagged panel, latent change score, and random-intercept cross-lagged panel) were estimated for each indicator of psychological adjustment. Findings indicated that the healthy context paradox emerges because classroom-level victimization moderates the prospective effect of victimization on psychological problems, rather than the effect of psychological problems on victimization. In classrooms with lower victimization, victims not only experience worse psychological maladjustment over time compared to others (between-person changes), but also higher maladjustment than before (absolute within-person changes).

The healthy context paradox of bullying victimization and academic adjustment among Chinese adolescents: A moderated mediation model

Few empirical studies have specifically examined the underlying mechanisms of the "healthy context paradox" in Chinese cultural context. By constructing a moderated mediation model, the present study investigated the relationship between bullying victimization and academic adjustment, as well as the mediating effects of subjective well-being and the moderating role of classroom-level victimization. A sample of 631 adolescents (Mage = 13.75, SD = 0.74, 318 boys) were recruited from four schools in Hubei, Southern China. Results show that: (1) classroom-level victimization moderates the relationship between bullying victimization and academic adjustment. (2) Classroom-level victimization moderates the association through subjective well-being. This study confirms the healthy context paradox of bullying victimization and first reveals the mechanism of the mediating role of subjective well-being. Understanding the mechanisms that contribute to the health context paradox is crucial for developing targeted intervention strategies for individuals who experience ongoing bullying.

Adolescent Peer Victimization and Deliberate Self-Harm: A Three-Wave Moderated Mediation Model

Background: Identifying deliberate self-harm (DSH) and peer victimization in adolescents is a public health issue. The present study evaluates a three-wave longitudinal model to examine the effect of peer victimization on DSH and the roles of internalizing problems (depression and anxiety) and perceived peer and teacher support climate in this relationship. Methods: The participants were 2381 adolescents (51.2% boys, Mage = 13.38, SD = .59) from Chinese middle schools. Self-report measures were used to collect data every 6 months in three waves. Results: (1) Peer victimization at T1 positively predicted DSH at T3. (2) Depression at T2, rather than anxiety, mediated the relationship between peer victimization at T1 and DSH at T3. (3) Perceived peer support climate at T1 played a moderating role between peer victimization at T1 and depression and anxiety at T2, but perceived teacher support climate did not. Peer victimization had a stronger predictive effect on depression and anxiety for students with high level of perceived peer support climate. Limitations: Study limitations include the short interval (6 months) of the longitudinal design, the reliance on self-report questionnaires, the inclusion of only one aspect of student-student and teacher-student relationships, and the age limitation. Conclusions: The results demonstrated the importance of prevention for improving social and emotional skills to reduce peer victimization and of interventions to promote a peer support climate in the classroom. The findings highlight the need to consider different types of internalizing problems and perceived support in studies of DSH in adolescents.

Lower Levels of Classroom Aggression Predict Stronger Relations Between Peer Victimization and Reactive Versus Proactive Aggression

We examined the concurrent relations of children's reactive and proactive aggression with their experience of peer victimization. Extending previous research, we assessed these relations at both the child and classroom levels. We predicted that reactive aggression would relate positively to peer victimization, proactive aggression would relate negatively to peer victimization, and that these relations would vary with classroom levels of aggression. Participants included 1,291 fourth- and fifth-grade children (681 girls; M age = 10.14 years) and their 72 teachers from 9 schools in one public school district in the Mid-Atlantic United States. Children completed self-report measures of peer victimization and teachers completed measures of aggression for each child in their classrooms. Via two-level regression (level 1 = child; level 2 = classroom), reactive aggression related positively to peer victimization and proactive aggression related negatively to peer victimization. The positive relation between reactive aggression and peer victimization was only significant in classrooms with low levels of reactive aggression. The negative relation between proactive aggression and peer victimization was only significant in classrooms with low levels of proactive aggression. Our hypotheses were supported and offered further evidence for differential relations of reactive and proactive aggression with peer victimization at the child level, while demonstrating the important role of classroom norms for aggression in moderating these relations.

Teacher victimization and teachers' subjective well-being: Does school climate matter?

Guided by the job demands-resources model, we examined the multilevel associations between victimization experience with student violence directed against teachers, school climate, and teachers' subjective well-being (i.e., school connectedness and teaching efficacy) among 1711 teachers (7th-12th grade) from 58 middle and high schools in China. Hierarchical linear modeling analyses revealed that teachers who reported more frequent teacher victimization perceived a lower level of teaching efficacy; however, teachers in schools with a higher level of teacher victimization scores at the school level perceived a higher level of teaching efficacy. Although school climate was positively related to teacher well-being at both teacher and school levels, the negative association between teacher victimization and teachers' subjective well-being at the teacher level was exacerbated in schools with a more positive school climate at the school level. The significant cross-level moderating effect of school-level school climate in the association between teacher-level victimization and subjective well-being was consistent with the "healthy context paradox" but contradicted with the "emotion contagion hypothesis." Our findings support the risk influence of teacher victimization and the promotive role of positive school climate on teachers' subjective well-being. Our results also indicate that teachers in schools with a more positive and collective perception of school climate tend to be more attuned to the negative influences of teacher victimization on their subjective well-being than teachers in schools with a less positive and collective perception of school climate.

Empirical and theoretical foundations of family interventions to reduce the incidence and mental health impacts of school bullying victimization

Bullying victimisation is a serious risk factor for mental health problems in children and adolescents. School bullying prevention programs have consistently produced small to moderate reductions in victimisation and perpetration. However, these programs do not necessarily help all students affected by bullying. Paradoxically whole-school programs lead to higher levels of depression and poorer self-esteem for students who continue to be victimised after program implementation. This may be because some elements of whole-school programs make victims more visible to their peers, thus further eroding their peer social status. Three main identified risk factors for children and adolescents who continue to be victimised following school bullying prevention programs are peer rejection, internalising problems, and lower quality parent-child relationships. All are potentially modifiable through family interventions. A large body of research demonstrates the influence of families on children's social skills, peer relationships and emotional regulation. This paper describes the theoretical foundations and empirical evidence for reducing the incidence and mental health outcomes of school bullying victimisation through family interventions. Family interventions should be available to complement school efforts to reduce bullying and improve the mental health of young people.

The Healthy Context Paradox: When Reducing Bullying comes at a Cost to Certain Victims

Bullying remains one of the most serious problems affecting school systems around the world. The negative consequences of bullying in the short and long term have been widely documented, showing that victimized students are at greater risk of suffering psychosocial distress. In this paper, we first summarize the current situation of bullying prevention, adopting a contextual perspective, and briefly highlighting the characteristics of the most effective prevention programs. Secondly, we address a disturbing phenomenon detected in classrooms where bullying has been reduced through interventions and which has been termed “the healthy context paradox”. In these healthier contexts, students who remain in a situation of victimization have been found to present poorer psychological adjustment after the intervention. Understanding the causes of this phenomenon may offer clues for the prevention of bullying. In this regard, we present three hypotheses recently proposed to explain the phenomenon. Finally, we offer some implications for the study and prevention of bullying derived from “the healthy context paradox”.

Bullying Prevention in Adolescence: Solutions and New Challenges from the Past Decade

Bullying among youth at school continues to be a global challenge. Being exposed to bullying may be especially hurtful in adolescence, a vulnerable period during which both peer group belonging and status become key concerns. In the current review, we first summarize the effectiveness of the solutions that were offered a decade ago in the form of anti-bullying programs. We proceed by highlighting some intriguing challenges concomitant to, or emerging from these solutions, focusing especially on their relevance during adolescence. These challenges are related to (1) the relatively weak, and highly variable effects of anti-bullying programs, (2) the complex associations among bullying, victimization, and social status, (3) the questions raised regarding the beneficial (or possibly iatrogenic) effects of peer defending, and (4) the healthy context paradox, that is, the phenomenon of remaining or emerging victims being worse off in contexts where the average levels of victimization decrease. We end by providing some suggestions for the next decade of research in the area of bullying prevention among adolescents.

Why Does Classroom-Level Victimization Moderate the Association Between Victimization and Depressive Symptoms? The "Healthy Context Paradox" and Two Explanations

The present longitudinal study examined how and why classroom-level victimization moderates the prospective association between peer victimization and depressive symptoms with 2,643 third- and fourth-graders (M_age  = 10.01 years) in China. Multilevel modeling revealed that peer victimization was more strongly associated with increasing depressive symptoms in classrooms with lower classroom-level victimization. Moreover, two mechanisms were identified to explain the moderating effect of classroom-level victimization. First, low classroom-level victimization reduced victimized children's received friendship nominations from peers, thereby leading to increases in depressive affect. Second, low classroom-level victimization affected victimized children's depressive symptoms through damage to their social self-concept. These findings provide support for the "healthy context paradox" in the Chinese culture, and highlight the mechanisms of this phenomenon.

A Large-Scale Replication of the Effectiveness of the KiVa Antibullying Program: a Randomized Controlled Trial in the Netherlands

This study evaluates the effectiveness of the KiVa antibullying program in the Netherlands through a randomized controlled trial of students in grades 3-4 (Dutch grades 5-6). The sample involved 98 schools who volunteered to participate in the research, with 245 classes and 4383 students at the baseline (49% girls; M age = 8.7 years), who participated in five measurement waves, collected in three consecutive school years. After the baseline, two-thirds of the schools were assigned to the intervention condition (KiVa or KiVa+, the latter included an additional intervention component of network feedback to teachers) and one-third to the control condition (waiting list, care as usual) with a stratified randomization procedure. The effects of the intervention on self-reported victimization and bullying were tested using cross-classified ordered multinomial models and binomial logistic regression models. These longitudinal models showed that self-reported victimization and bullying reduced more strongly in KiVa-schools compared with control schools, with stronger effects after two school years than after one school year of implementation. The results showed that for students in control schools, the odds of being a victim were 1.29-1.63 higher, and the odds of being a bully were 1.19-1.66 higher than for KiVa students. No significant differences between KiVa and KiVa+ emerged. Overall, the findings provide evidence of the effectiveness of the KiVa program in the Netherlands.

The Role of Defending Norms in Victims' Classroom Climate Perceptions and Psychosocial Maladjustment in Secondary School

Victims of bullying are at increased risk of developing psychosocial problems. It is often claimed that it helps victims when others stand up against the bullying and when defending is typical (descriptive norm) or rewarded with popularity (popularity norm) in classrooms. However, recent work on the healthy context paradox suggests that victims – paradoxically – tend to do worse in more positive classrooms. Therefore, it is possible that defending norms are counterproductive and exacerbate victims’ adjustment difficulties, possibly because social maladjustment is more apparent in classrooms where everybody else is doing well. The current study examined whether descriptive and popularity norms for defending predicted victims’ classroom climate perceptions and psychosocial adjustment. Using data of 1,206 secondary school students from 45 classrooms (M_age = 13.61), multi-level analyses indicated that descriptive norms for defending increased rather than decreased negative classroom climate perceptions and maladjustment of victimized youths. In contrast, popularity norms for defending positively predicted all students’ classroom climate perceptions and feelings of belonging, except victims’ self-esteem. Interventions may benefit more from promoting popularity norms for defending rather than descriptive norms for defending in secondary schools.

How School Contexts Shape the Relations Among Adolescents' Beliefs, Peer Victimization, and Depressive Symptoms

The present research examined how school contexts shape the extent to which beliefs about the potential for change (implicit theories) interact with social adversity to predict depressive symptoms. A preregistered multilevel regression analysis using data from 6,237 ninth-grade adolescents in 25 U.S. high schools showed a three-way interaction: Implicit theories moderated the associations between victimization and depressive symptoms only in schools with high levels of school-level victimization, but not in schools with low victimization levels. In high-victimization schools, adolescents who believed that people cannot change (an entity theory of personality) were more depressed when they were victimized more frequently. Thus, the mental health correlates of adolescents' implicit theories depend on both personal experiences and the norms in the context.

Navigating the Healthy Context Paradox: Identifying Classroom Characteristics that Improve the Psychological Adjustment of Bullying Victims

The healthy context paradox—an unexpected pattern in which victims’ psychological adjustment worsens as the overall level of victimization in a classroom or school declines—implies that reducing the frequency of bullying or victimization incidents does not do enough to help victims of bullying. In light of this finding, it is imperative to identify protective factors that alleviate victimization-related distress in the peer ecology. The current study examines classroom-level peer victimization and peer-defending behaviors as moderators of the association between individual-level victimization and psychological adjustment. These classroom-level moderators were tested with a sample of 1373 adolescents (40% girls, M_age: 14 years) from 54 classrooms in South Korean middle schools. Consistent with past findings documenting the healthy context paradox, the results of multilevel modeling indicated that victimized youth experienced a lower level of depressive symptoms in classrooms where victimization was more common. Most importantly, bullied students reported fewer depressive symptoms, on average, in classrooms with relatively high levels of bully-oriented (i.e., confronting the bully), rather than victim-oriented (i.e., comforting the victim), defending behavior. These findings provide a more nuanced understanding of the role of peers’ defending behaviors toward bullied adolescents and have significant implications for anti-bullying interventions.

Brief antibullying intervention for adolescents in public schools

ABSTRACT Objectives: To assess the results of a brief antibullying intervention for adolescents in public schools. Method: This was a controlled experimental study whose subjects were 1,043 students in 5th through 9th grades from public schools in Porto Alegre/State of Rio Grande do Sul, conducted between April and November 2015. Adolescents and school teachers randomly assigned to the intervention group participated in two meetings focused on educative aspects of bullying. Outcome was assessed using the Bullying Questionnaire - victim and perpetrator version. Generalized Estimating Equations was used to evaluate the effect of the intervention. Results: Average age of subjects was 12.5 (SD=1.62) years. A total of 613 (58.7%) adolescents participated in interventions. They were compared to 430 (41.3%) participants in the control group. The study did not observe any significant difference in bullying scores after the intervention. Conclusions: This study indicates the usefulness of clarifying precisely what bullying is in schools as part of an initial approach to an educative strategy on this topic.

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 emotional learning (SEL) practices in schools: Effects on perceptions of bullying victimization

The direct and indirect effects of student perceptions of the extent to which social emotional learning (SEL) instruction is provided on bullying at school and student victimization experiences were examined for 2832 public school students. Students in grades 4-12 completed several subscales of the Delaware School Climate Survey (Bear et al., 2016) at a single timepoint to assess their perceptions of the extent to which SEL instruction is used at their school, their own SEL skills, bullying at school, and personal victimization experiences. Structural equation modeling revealed that students' perceptions of SEL instruction were inversely related to their perceptions of bullying at school and students' personal experiences of victimization. Effects were direct and indirect, through students' self-reported perceptions of their SEL skills. Effects were stronger in late elementary and middle school than in high school. The indirect effects of student perceptions of the extent of SEL instruction on perceived bullying at school through students' SEL skills varied as a function of victimization severity. For students with low self-reported victimization, there was a negative relation between student self-reported SEL skills and perceptions of bullying at school. In contrast, for students who reported experiencing high levels of victimization, students' self-reported SEL skills related positively to perceptions of bullying at school; there was no significant relation between SEL skills and perceptions of bullying at school for students who reported moderate levels of victimization. Implications for teachers' inclusion of SEL instruction and its effects on positive youth development are discussed.

Dynamic Changes in Peer Victimization and Adjustment Across Middle School: Does Friends' Victimization Alleviate Distress?

Although some adolescents are chronically bullied throughout middle school, others may only experience peer victimization temporarily. This study examined the effects of time-invariant (average level) and time-varying (year-to-year) victimization experiences across middle school on adolescents' depressive symptoms, somatic complaints, and self-blame. A key question was whether friends' victimization buffered students from their victimization-related distress. The diverse sample (n = 5,991) was surveyed four times between sixth and eighth grade (M_age at sixth grade = 11.54 years). Three-level multilevel models revealed both time-invariant and time-varying effects of victimization on adjustment, but these maladaptive associations were attenuated when adolescents' friends experienced more victimization across middle school. The results suggest that even temporarily victimized youth may have unmet mental health needs, and sharing social plight with friends can protect victims.