The effectiveness of school-based bullying prevention programs: A systematic review
Introduction
School bullying is a serious social problem. Bullying includes both direct aggressive behavior (e.g., physical intimidation, verbal threats) and indirect aggressive behavior (e.g., exclusion, rejection). Typically, bullying has four related forms or dimensions: physical (i.e., physical force such as hitting or kicking), verbal (i.e., oral or written communication such as teasing or name calling), relational (i.e., direct or indirect actions intended to harm the victims' reputation and relationships such as rumor spreading or physically or electronically posting embarrassing images of the victim), and damage to property (i.e., stealing or damaging the possessions or property of victims; Gladden, Vivolo-Kantor, Hamburger, & Lumpkin, 2014). In addition, bullying has three defining features: intent to harm (i.e., the bully intends to harm the victim), imbalance of power (i.e., the bully is physically stronger and/or has more social power than the victim), and repetition (i.e., the bullying is focused on particular children and occurs repeatedly; Olweus, 1993).
As a social dynamic, bullying involves a large proportion of elementary, middle, and high school students. Given the lack of national studies, the prevalence of bullying among elementary school-aged children must be estimated from local and state survey studies. For example, in a sample of 3530 students in Grades 3 thru 5 enrolled in an urban school district on the West Coast of the United States, 22% of students reported involvement in bullying as a bully, a victim, or a bully/victim (Glew, Fan, Katon, Rivara, & Kernic, 2005). The majority of national studies of bullying have used samples from middle and high schools. A national survey of 15,686 students in Grades 6 thru 10 reported 30% of students appeared to be involved in bullying as a bully, victim, or bully/victim in the current semester (Nansel et al., 2001). A more recent national survey, the School Crime Supplement to the National Crime Victimization Survey, examined 4326 adolescents and found 28% reported bullying victimization (National Center for Educational Statistics, 2011). In addition, the national Health Behavior in School Aged Children survey of 7182 students in Grades 6 thru 10 reported that the most prevalent form of bullying was verbal bullying (e.g., teasing, name calling) with 54% of students reporting involvement in the past 2 months. Other prevalent forms of bullying included relational bullying (i.e., exclusion; 51%), physical bullying (21%), and victimization using electronic media or cyber bullying (14%; Wang, Iannotti, & Nansel, 2009).
Bullying is a peer-group process and children can be actively involved as bullies, victims, or bully/victims. Moreover, children can be passively involved as bystanders, offering varying degrees of support to bullies or victims (Salmivalli, 2010). Research has suggested that a child's active participation in bullying has negative developmental consequences (Gladstone et al., 2006, Ttofi et al., 2012, Ttofi et al., 2011a). As discussed later, these negative sequelae include depression, anxiety, relationship difficulties, and criminal behavior. As these negative outcomes have become more widely recognized among policy makers, educators, and scholars, a variety of school-based bullying intervention programs have been developed.
Farrington and Ttofi (2009) conducted a systematic review of 44 bullying interventions tested in controlled trials. The results of their meta-analysis showed that, on average and when compared with routine school services, these programs decreased bullying between 20% and 23% and reduced victimization between 17% and 20%. For example, in a cluster randomized trial of elementary students in Grades 3 thru 5 (N = 1345), Fonagy et al. (2009) estimated the program effect of the Creating a Peaceful School Learning Environment (CAPSLE) intervention on bullying and victimization. Using a cluster sample of nine elementary schools, Fonagy and colleagues randomly assigned the schools to participate in one of two treatment conditions (i.e., CAPSLE or psychiatric consultation, in which psychiatrists provided individual consultation to children with problematic behaviors), or the treatment-as-usual control condition. The study results showed that after 2 years of program implementation, the CAPSLE program reduced bullying victimization. A comparison of victimization reports showed that 19% of students in the CAPSLE program reported victimization compared with 25% of children who received psychiatric consultation and 26% of children in the control condition.
From their review, Farrington and Ttofi (2009) distilled elements of effective anti-bullying programs such as: presence of parent and teacher training, use of classroom disciplinary methods (i.e., strict rules for handling bullying), implementation of a whole-school anti-bullying policy, and the use of instructional videos. These elements were positively correlated with a reduction in bullying and victimization. In addition, Farrington and Ttofi found that program duration and intensity were related to decreased bullying and victimization, and interventions inspired by the work of Dan Olweus appeared to be more successful.
Characteristics of studies were also related to bullying outcomes. Farrington and Ttofi (2009) found that studies using more rigorous designs produced lower effect estimates. Expressed as an odds ratio (OR), the average effect size for bullying was 1.10 for randomized experiments, 1.60 for before–after experimental control, 1.20 for other experimental-control, and 1.51 for age-cohort designs. Across designs, the mean OR was 1.36 (Farrington & Ttofi, 2009). On average, intervention groups had bullying rates 1.36 times lower than control groups. Programs focused on older children (i.e., 11 years or older) had larger effect sizes. In fact, when age was divided into four categories (i.e., 6–9 years, 10 years, 11–12 years, and 13–14 years) the weighted mean OR steadily increased for both bullying and victimization. In addition Farrington and Ttofi observed that programs implemented in Europe were more successful than programs implemented in the United States.
Compared with youth who reported no involvement in bullying, those youth who reported involvement as bullies, victims, or bully/victims reported poorer psychosocial adjustment (Aluede et al., 2008, Gini, 2008, Kaltiala-Heino et al., 1999, Nansel et al., 2001). Although bullies, victims, and bully/victims share some risk-related characteristics, outcomes vary. For example, in elementary school, victims and bully/victims have been shown to have more serious adjustment problems than bullies. In a sample of 565 students in Grades 3 thru 5, teacher reports and child self-reports indicated that as compared with noninvolved children, both victims and bully/victims experienced higher levels of psychosomatic symptoms (e.g., feeling tired, dizzy, tense) whereas only victims experienced greater psychosocial difficulties (e.g., conduct problems, hyperactivity, problems with peers). Bullies were similar to noninvolved youth, but bullies reported higher levels of sleeping problems, feeling tense, and hyperactivity (Gini, 2008).
Consistent with these findings, a study with a sample of Grade 6 students found that victims of bullying reported the highest levels of depression, social anxiety, and loneliness as compared with bullies, bully/victims, and noninvolved youth (Juvonen, Graham, & Schuster, 2003). This pattern of negative outcomes appears to persist into high school, as evidenced by a study with a sample of older youth (i.e., mean age 15 years) in which youth who were consistently victims and bully/victims, reported higher levels of depression, anxiety, and withdrawal as compared to bullies and noninvolved youth. In contrast, a different study with bullies reported the perpetrators experienced more externalizing problems (e.g., aggression) than their victims or bully/victims (Menesini, Modena, & Tani, 2009). The data tend to support a description of victims as lonely, anxious, and insecure (Olweus, 1993) and suggest that victimization is associated with deficits in social competence, feelings of powerlessness, rejection by peers (Kvarme et al., 2010, Nation et al., 2008) and decreased academic achievement (Glew et al., 2005).
In contrast to victims, bullies tend to be more aggressive (Olweus, 1993). For example, in a study with a sample of 23,345 students in elementary, middle, and high school comparing bullies and noninvolved youth, O'Brennan, Bradshaw, and Sawyer (2009) found that bullies were more likely to endorse reacting to provocation with aggression. Bullies often have a low level of school commitment and are at increased risk of dropping out and using substances (Vanderbilt & Augustyn, 2010). Moreover, bullies tend to display higher levels of hyperactivity than either victims or bully/victims (Gini, 2008).
Both internalizing disorders and suicidal ideation have been reported among bullies as well as their victims. In a sample of 16,410 Finnish adolescents ages 14 to 16 years, depression and suicidal ideation were observed more frequently among bully/victims, followed by victims, and then bullies relative to adolescents with no bullying involvement (Kaltiala-Heino et al., 1999). Controlling for age, gender, and depression to assess risk for suicidal cognition, Kaltiala-Heino et al. created a statistical model, in which bullies were found to have the highest risk of suicidal ideation, followed by bully/victims, and then victims. These Northern European data suggest that bullies may be at higher risk for suicide than previously thought (Kaltiala-Heino et al., 1999).
The effects of bullying involvement appear to persist into young adulthood (Ttofi et al., 2012). Indeed, those who were bullies or who were the victims of bullies during childhood or adolescence face increased risk as adults for health problems and poor social and emotional adjustment (Vanderbilt & Augustyn, 2010). Although the threshold level of exposure is not clear, studies suggest that victimization is associated with both internalizing and externalizing problems. For example, a meta-analysis of 29 studies found that childhood bullying victimization led to increased rates of depression that persisted up to 36 years post-victimization, with an average duration of 6.9 years post-victimization (Ttofi et al., 2011a). In addition, as adults, the victims of childhood bullying were at increased risk for experiencing internalizing disorders such as anxiety (Gladstone et al., 2006). A meta-analysis of 51 reports of 28 longitudinal studies found that childhood victimization was associated with the continued presence of aggressive (e.g., fighting) and violent (e.g., assault, robbery, rape, carrying or shooting a firearm) behaviors with an average of 6 years after victimization (Ttofi et al., 2012).
A recent meta-analysis of 28 studies comparing nonbullies and bullies found that bullies displayed increased levels of criminal offending up to 11 years post-bullying perpetration (Ttofi, Farrington, Losel, & Loeber, 2011b). One study included in this meta-analysis used a sample of 957 youth from the Healthy Children Project, which recruited participants from 10 suburban public elementary schools in the U.S. Pacific Northwest region (Kim, Catalano, Haggerty, & Abbott, 2011). The researchers found that bullying in Grade 5 predicted increased rates of problem behaviors at age 21 years, including violence (e.g., started a fight, hit someone to seriously harm them, carried a hand gun), heavy drinking (e.g., consuming more than 4 [females] or 5 [males] drinks in a row), and marijuana use. Moreover, the study found moderate correlations between bullying in Grade 5 and young adults' (i.e., 21 years) problematic behaviors such as impulsivity (r = .27), poor family management (r = .39), and antisocial peer association (r = .41; Kim et al., 2011). In summary, the data suggest that victimization and bullying are related to ongoing difficulties with social, psychological, and academic adjustment. Early reports suggested that bully prevention programs might be effective in reducing bullying. Because bullying appears to be part of a cascade of risks related to negative developmental sequelae, the effectiveness of bullying prevention programs can be important in promoting positive youth and life course outcomes.
Since the publication of Farrington and Ttofi's (2009) meta-analysis, additional bullying prevention programs have been evaluated. The aim of the current study was to extend the work of Farrington and Ttofi by assessing controlled trials of bullying interventions published from June, 2009 through April, 2013.
Section snippets
Search strategy
Our review followed AMSTAR (A Measurement Tool to Assess Systematic Reviews) guidelines for conducting systematic reviews (e.g., an established research question, a documented list of inclusion criteria, a comprehensive literature search; Shea et al., 2007). We identified potential articles, book chapters, and dissertations for review by searching 12 databases: Campbell Collaboration, Cochran Library, Dissertation Abstracts, ERIC, Google Scholar, Index to Thesis Database, PsycInfo, PubMed,
Results
Displayed in Table 1, the search protocol yielded 32 articles that evaluated 24 distinct bullying interventions. Each article described a controlled trial of a bullying prevention program and measured (a) perpetration and victimization (17 studies), (b) victimization only (10 studies), or perpetration only (five studies). Results are discussed in terms of changes in victimization or perpetration. Thus, 27 studies measured victimization (17 examined both perpetration and victimization, 10
Discussion
Overall, the findings from evaluations of anti-bullying programs are mixed. Of the 22 controlled trials with measures of bullying perpetration, 11 trials (50%) reported significant program effects on bullying behavior, and one reported mixed results. Of the 27 studies that assessed victimization, 18 (67%) reported significant program effects, and one reported mixed results. To be sure, the evidence is sufficiently strong to indicate that bullying interventions can be effective. At the same
Conclusion
Overall, the findings are mixed. Although effective bullying interventions were identified, up to 45% (i.e., 10 of 22 studies) of the studies showed no program effects on bullying perpetration and 30% (i.e., 8 of 27 studies) showed no program effects on victimization. Of the studies reporting significant effects, compromised measurement reduces the confidence policymakers and others might have that programs are reducing bullying behavior. Among the more rigorously measured programs (i.e., those
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*denotes articles included in this review.