Research with youth and adults shows that negative social interactions are experienced as particularly stressful. Stress causes the body to secrete the stress hormone cortisol. Cortisol impairs immune system functioning, leaving the individual more vulnerable and less able to combat physical illnesses (1, 2).
Is There a Connection Between Bullying and Health?
The connection between social stress, such as bullying and health has been observed for some time by school nurses and other health professionals who regularly come into contact with youth in the context of schools. Children who are bullied are more likely to report experiencing migraine and non-migraine headaches than are their non-bullied counterparts (3). Colleagues and I have found that students who get picked on frequently also miss more school because of both excused and unexcused absences (4, 5).
Evidence for an association between bullying and physical complaints has now been documented in different age groups (elementary to high school) and countries (e.g., Australia, Finland, United Kingdom, United States) (3, 5, 7, 8).
In two recent studies, colleagues and I examined whether bullying was related to physical symptoms on a day-to-day basis and over the course of a school year.
- In the first study, I asked a group of 150 ethnically diverse sixth graders about their current symptoms (i.e.,"how are you feeling right now?") and also whether they had been picked on earlier that day or not (5, 6). Students answered these questions at the end of five randomly-selected school days. In order to make sure that their answer about being bullied did not influence how they were currently feeling, I asked students to report on their symptoms before they indicated whether they had been picked on that day. For physical symptoms, students indicated how much they were currently feeling "sick," "have a cough," "have a sore throat," "have a stuffy nose," "have a headache," and "have a stomachache." If a student said he or she had been bullied that day, I asked them to describe what had happened (e.g., called a name, put down, threatened, physically bullied, excluded, had a rumor spread about them, etc.). What happened on a day that a student experienced bullying compared to a day in which he or she did not experience bullying? On days that students reported getting personally picked on, they also reported increased physical symptoms of the sort described above. And this increase in physical symptoms was even stronger if the student said that he or she got picked on frequently at school (e.g., several times a week). Thus, within a given school day, students were feeling sick when they got bullied earlier in the day.
- In a second study, the association between bullying and physical health was examined over the course of an academic school year (5). The sample for this study was approximately 1500 urban public middle school students from ethnically diverse backgrounds. In fall semester, colleagues and I asked students how often they were bullied at school and in spring semester, we asked them about both psychological well-being (depression,,anxiety, loneliness, and low self-worth) and physical symptoms (e.g., "sore throat/coughs," "upset stomach, nausea"). We also looked at their academic performance and attendance in school at the end of spring semester. These results were similar to the study described above. More frequent bullying experiences were associated with poorer psychological and physical well-being. That is, students who reported getting bullied reported feeling/getting sick more often later in the school year. They also reported feeling more depressed, anxious, and lonely, and lower self-worth.
Bullying Appears to Affect Students' Academic Performance
Not surprisingly, when students feel sick, depressed, worried, and/or isolated and alone, it is hard for them to perform to their potential in school (4, 5). Feeling sick and thinking about or anticipating bullying may interfere with students' ability to concentrate, which can reduce their ability to learn new material. In turn, students who felt down and sick as a function of bullying were absent from school more often and obtained lower grades. Interestingly, at least for physical symptoms, the reverse was not true. That is, whereas being bullied predicted later physical symptoms, kids who experienced a lot of physical symptoms did not later report getting bullied more. It may be that being sick limits bullying by peers and increases sympathy from others (5). At least for physical symptoms, then, it looks like bullying precedes feeling and getting sick. In sum, bullying appears to affect students' academic performance through physical and mental health.
Taken together, these two studies have results similar to those that have looked at change in actual physical well-being, such as changes in cortisol, due to every day stressors in adults (9) and observable chemical changes in the brain (10). Bullying is associated with a stress response that manifests itself as a host of physical and psychological symptoms, which in turn predicts poor academic performance.
Take Home Messages
The research on bullying and health offers a few take home messages for those who work with youth.
- First, frequent physical complaints may be warning signs that a child is being bullied. School nurses and office staff, in addition to parents and teachers, are likely to encounter students who complain of physical symptoms. Especially when such complaints take place during certain classes or activities, adults may want to inconspicuously monitor the child to see if bullying is contributing to the problem. For example, students frequently try to avoid physical education (PE) classes by reporting physical complaints. In some cases, this may be the results of avoiding the physical activities. However, in other cases, this may be a response to being bullied (11).
- Second, when youth report feeling sick, even if the symptoms appear to be socially motivated, they may not be "faking it." Such symptoms may be and feel real to the child. Additionally, legitimate frequent illnesses may have their roots in bullying. Social stress associated with bullying may lead children to become more vulnerable to illness. Teaching students stress management and coping skills should minimize the degree to which bullying is associated with illness.
- Finally, teachers and other adults in children's lives at school can help by limiting students' exposure to bullying. Adult involvement includes discretely intervening in bullying incidents both inside and outside (e.g., during lunch, recess, passing period) of the classroom. Public intervention may also be warranted when the bullying is public and observed by other students. Colleagues and I recommend that teachers and school staff consistently intervene whenever a bullying incident comes to their attention because the events that adults observe is a fraction of what students encounter on a daily basis. Thus, not only can adult intervention serve to reduce the physical toll on youth, but can also alleviate the psychological impact as well.
- Kemeny, M. E. (2003). The psychobiology of stress. Current Directions in Psychological Science, 12, 124-129.
- McEwen, B. S. (2000). The neurobiology of stress: from serendipity to clinical relevance. Brain Research, 886, 172-189.
- Metsaehonkala, L., Sillanpaeae, M., & Tuominen, J. (1998). Social environment and headache in 8- to 9-year-old children: A follow-up study. Headache, 38, 222-228.
- Juvonen, J., Nishina, A., & Graham, S. (2000). Peer harassment, psychological adjustment, and school functioning in early adolescence. Journal of Educational Psychology, 92, 349-359.
- Nishina, A., & Juvonen, J. (2005). Daily reports of witnessing and experiencing peer harassment in middle school. Child Development, 76, 435-450.
- Nishina, A. R. (2003). Peer victimization in school: Implications for mental health, physical symptoms, and school adjustment. Dissertation Abstracts International, 64 (01B).
- Rigby, K. (2001). Health consequences of bullying and its prevention in schools. In J. Juvonen, & S. Graham (Eds.), Peer harassment in school: The plight of the vulnerable and victimized (pp. 310-331). New York, NY: Guilford Press.
- Williams, K., Chambers, M., Logan, S., & Robinson, D. (1996). Associations of common health symptoms with bullying in primary school children. British Medical Journal, 313, 17-19.
- Saxbe, D. E., Repetti, R. L., & Nishina, A. (In press). Marital satisfaction, recovery from work, and diurnal cortisol among men and women. Health Psychology
- Eisenberger, N. I., Lieberman, M. D., & Williams, K. D. Does rejection hurt? An MRI study of social exclusion. Science, 302, 290-292.
- Cadigan, R. J. (2003). Scrubs: An ethnographic study of peer culture and harassment among sixth graders in an urban middle school. Dissertation Abstracts International, 63(7A), pp. 2597. (University Microfilms No. 3058487).