Bullying Victimization Prevalence and Its Effects on Psychosomatic Complaints: Can Sense of Coherence Make a Difference?

This is the peer reviewed version of the following article García-Moya, I., Suominen, S. and Moreno, C. (2014), Bullying Victimization Prevalence and Its Effects on Psychosomatic Complaints: Can Sense of Coherence Make a Difference?. J School Health, 84: 646-653, which has been published in final form at https://doi.org/10.1111/josh.12190. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited. Bullying Victimization Prevalence and Its Effects on Psychosomatic Complaints. Can Sense of Coherence Make a Difference? Irene García-Moya, MSc. (Corresponding author) Teaching and Research Fellow Department of Developmental and Educational Psychology, University of Seville, Spain. Address: C/ Camilo José Cela s/n. C.P: 41018 Sevilla (Spain) Phone: (+34) 954554331 E-mail: [email protected] Sakari Suominen, PhD. Clinical Lecturer and Professor of Public Health University of Turku, Department of Public Health; Nordic School of Public Health; Folkhälsan Research Center Addresses: - University of Turku. FI-20014 Turun Yliopisto. Finland. - Nordic School of Public Health NHV. P.O. Box 12133, SE-402 42 Göteborg. Sweden. - Folkhälsan Research Center. Paasikivigatan 4, FIN-00250. Helsinki. Finland. Phone: +358 2 333 8476 E-mail: [email protected] Carmen Moreno, PhD. Professor of Developmental and Educational Psychology 1 Department of Developmental and Educational Psychology, University of Seville, Spain. Address: C/ Camilo José Cela s/n. C.P: 41018 Sevilla (Spain) Phone: (+34) 954557678 E-mail: [email protected] 2 Bullying Victimization Prevalence and Its Effects on Psychosomatic Complaints. Can Sense of Coherence Make a Difference? ABSTRACT BACKGROUND: The aim of this study was to examine the prevalence of bullying victimization and its impact on physical and psychological complaints in a representative sample of adolescents and to explore the role of sense of coherence (SOC) in victimization prevalence and consequences. METHODS: A representative sample of Spanish adolescents (N = 7,580, M age = 15.41) was selected as part of the Health Behaviour in School-aged Children study. Bullying victimization, physical and psychological symptoms and SOC were measured, and comparisons were made between strongand weak-SOC adolescents regarding their likelihood of being a victim of bullying and the negative effects of bullying victimization on their health. RESULTS: Weak-SOC adolescents were significantly more likely to suffer from bullying victimization regardless of type (non-physical vs physical and non-physical) or means (traditional vs cyberbullying). In addition, bullying victimization showed significant increasing effects on weak-SOC adolescents’ physical and psychological symptoms whereas in strong-SOC adolescents it was not significantly associated with increases in physical complaints and its effects on psychological complaints seemed to be weaker. CONCLUSIONS: Weak-SOC adolescents seem to be at higher risk of becoming bullying victims and victimization experiences appear to have increased negative effects on them when compared to strong-SOC students. Keywords: bullying; cyberbullying; victimization; sense of coherence; salutogenesis; adolescence. 3 Bullying is a complex phenomenon, which has motivated scientific research worldwide. The wide array of negative consequences that bullying experiences cause makes this phenomenon of international interest, despite differences in prevalence rates of bullying victimization across countries.1 Additionally, since bullying episodes peak at the beginning of adolescence, much research has focused on this developmental stage. Bullying occurs when an student is exposed to negative actions on the part of one or more other students, in a way that is consistent with the three following characteristics: it is intentionally harmful, it is carried out repetitively and over time and there is an imbalance of power between the bully and the victim.2 One common classification of types of bullying distinguishes between physical, verbal and relational bullying. Among these types, verbal victimization seems to be the most prevalent, and interesting sex differences have been reported, with boys showing a higher likelihood of being involved, as bullies or victims, in overly physical or verbal abuse whereas girls are more prone to be engaged in or being victims of relational bullying.3,4 In the last decades, as a result of the increasing presence of new technologies in everyday life, a new and challenging type of bullying has emerged: cyberbullying. Cyberbullying is defined as the use of the Internet or other electronic communication devices, such as cellphones, as a medium to harass or hurt someone.5 Although cyberbullying is usually considered a new type of bullying, an alternative view is that it is a new means of committing bullying, which makes it possible to extend bullying outside the school limits.6,7 In this vein, some studies show that most cyberbullying victims are also victims of traditional bullying.8-10 Traditional bullying victimization has well-documented negative consequences; victims tend to be more depressed, more lonely and more generally and socially anxious and to have a lower self-esteem than non-victims.11 Less is known about the effects of cyberbullying. The 4 anonymity and the wider breadth of audience in cyberbullying could make it more damaging than traditional bullying, but some studies report less or similar negative emotional consequences on cyberbullying victims compared to traditional bullying victims.12 According to Smith et al.,10 the impact on the victim will depend on the type of cyberbullying, with certain types having more negative effects than traditional bullying whereas others tend to be less damaging. Nevertheless, it seems that the combination of traditional and cyber victimization places the victims at an increased risk of internalizing adjustment problems.8 Coping strategies employed by victims have also started to be studied recently, since they have significant effects on victimization duration and consequences. Thus, it seems that helplessness and counter-aggression tend to perpetuate bullying, whereas ignoring the bully, assertively asking the bully to stop or seeking help may be more effective to put a stop to the victimization experience.13 As noted by Stassen Berger,14 almost every student is hurt on occasion, but whereas most of them find protective tactics, those who are anxious, hostile, or sensitive may trigger repetition and finally become victims. In a similar vein, KochenderferLadd and Ladd15 have claimed that features of victimization experiences should be studied in relation to internal psychological characteristics of the victims, since individual factors may explain why similar experiences play some students at greater risk than others. Inasmuch as individual appraisals and coping abilities can have significant effects on bullying victimization duration and consequences, including individual variables related to these aspects in investigation of the associations between victimization and health seems warranted. In this respect, sense of coherence (SOC) can be viewed as a promising concept, due to its relevant role in understanding individuals’ capacity to deal with stressors. SOC, the central construct in the salutogenic model, is defined as ‘a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of 5 confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable (comprehensibility); (2) the resources are available to one to meet the demands posed by the stimuli (manageability); and (3) these demands are challenges, worthy of investment and engagement (meaningfulness)’.16 SOC has been proven to be an important factor in maintaining and regaining health.17 A lower tendency to interpret life situations as threatening and an increased ability to select appropriate coping strategies and to mobilize resources are two of the pathways proposed to explain SOC protective effects on health. Furthermore, even when the individual is confronted with strain, a strong SOC is hypothesized to prevent or at least reduce their negative effects on health.16 Despite that, to our knowledge no studies on bullying victimization have analyzed the role of SOC. Nevertheless, research has shown that SOC had a negative association with levels of psychopathology in a sample of juvenile delinquents exposed to community violence victimization18 and, in adult populations, SOC has been found to act as a protective mechanism among targets of workplace bullying, though this protective effect seemed to diminish when bullying was very severe.19 It has also been suggested that individuals with a weaker SOC may be at a higher risk of exposure to violence due to their poorer coping abilities to deal with work conflicts.20 Regarding the school context, Torsheim and colleagues21 found that a stronger SOC was significantly associated with lower levels of school-related stress and that the association between school-related stress and health complaints may be less strong for strong-SOC students. Strong-SOC adolescents also showed a lower likelihood of experiencing weekly headaches and of using medicine as a coping mechanism if suffering from them.22 In the present study, we analyzed the prevalence of different types of victimization experiences and the effects of different types of bullying on physical and psychological 6 complaints. Our analyses on the effects of type of bullying victimization and health will include comparisons between traditional bullying and cyberbullying, since this is an area in which discrepancies have been found. In addition, the role of SOC will be explored regarding both aspects (victimization prevalence and its impact on physical and psychological complaints), so that some insight may be obtained about potential differences between strong-SOC and weakSOC adolescents’ experiences of victimization. In line with the aforementioned SOC research regarding workplace bullying and school-related strain, we hypothesized that weak-SOC students may be at a higher risk of bullying victimization and that they may be more vulnerable to the negative effects on health of being bullied than strong-SOC students. METHODS Participants and Procedure A representative sample of adolescents aged 11 to 18 was selected as part of the 2010 edition of the study Health Behaviour in School-aged Children in Spain by means of random multistage sampling stratified by conglomerates. Data collection was conducted on-line in accordance with the HBSC international standardized procedure23 and students’ anonymity was ensured. Data collection took place from March to June 2010. Both the Spanish HBSC questionnaire and the survey procedure were approved by the Experimentation Ethical Committee of the University of Seville. From the original sample, we selected the 7,580 adolescents (M age = 15.41, SD =1.44) that had answered to the scales of interest in the present study. Adolescents aged 11 and 12 were excluded because the SOC scale was not part of their questionnaires. Instruments 7 The following measures from the HBSC questionnaire were employed for the purpose of this study: Bullying. This content was assessed by means of the Revised Bully/Victim Questionnaire.24 Apart from the global report on bullying victimization and reports on seven types of victimization experiences provided by the questionnaire, we developed an additional indicator, labeled observed bullying, using the maximum frequency function on the seven questions of bullying victimization experiences so that adolescents that reported having been a victim for at least one of them were considered victims. This strategy was employed in the hypothesis that some types of bullying experiences may be more likely than others to be considered bullying and consequently adolescents’ global self-report on bullying may be an underestimation of the actual bullying victimization prevalence. To identify bullying victims, we used the cut-off point proposed by Solberg and Olweus25 according to which adolescents were considered victims when they reported a bullying victimization frequency of two or three times a month or higher. Physical and psychological complaints. These variables were measured by means of the HBSC Symptom Checklist,26 a non-clinical measure of physical and mental health that assesses the frequency of psychosomatic symptoms in the last 6 months. This is an 8-item scale that has been validated in adolescent samples and provides separate information about two interrelated components: psychological complaints (feeling nervous, feeling low, irritability and sleeping difficulties) and somatic complaints (headache, abdominal pain, backache and dizziness). 27 The scores range from 1 (Rarely or never) to 5 (Almost everyday). Cronbach alpha in the present study was .71 for physical symptoms and .78 for psychological symptoms. 8 SOC. Sense of coherence was assessed by means of the SOC-29 scale.16 The SOC-29 scale has shown good psychometric properties in numerous studies.28,29 In the present study, reliability was .87. Given the lack of validated cut-off points, we used quartiles as a reference to distinguish between strong SOC (quartiles 1 and 2) and weak SOC (quartiles 3 and 4). Data Analysis We calculated prevalence for global victimization and specific victimization experiences in the total sample as well as in boys and girls separately and explored how different bullying victimization experiences combined. Chi-square and Crammer’s V were employed to analyze whether significant differences existed between boys and girls in the aforementioned aspects. Afterward, we developed two indicators of bullying: type of bullying and means of bullying, which are consistent with the suggestion by Ybarra and colleagues30 of a distinction between type and mode of bullying, and studied prevalence differences between strong-SOC and weak-SOC adolescents. General linear models, using type of bullying and means of bullying as predictors, were employed to analyze the associations between being a victim of bullying and physical and psychological symptoms. Given the well-known sex differences on physical and psychological symptoms,31 the possibility of sex x bullying interactions was considered. After conducting each of these analyses on the sample as a whole, strong-SOC and weak-SOC adolescents’ results were compared. RESULTS The percentages of bullying victims are presented in Table 1. Rumors or gossip (10.5%), sexual jokes (9.6%), and being called mean names or made fun of in a hurtful way (9.53%) were the most prevalent types of bullying, whereas being bullied using new technologies, either computers (4.0%) or mobile phones (3.6%) were the least prevalent conditions. No sex differences existed in the prevalence of being bullied, except for the item “I was hit, kicked, 15 IMPLICATIONS FOR SCHOOL HEALTH Results of the present study indicate that strong-SOC students seem to be less likely to become bullying victims and that a strong SOC may buffer or attenuate victimization negative effects on health. The cross-sectional design of the study does not allow drawing conclusions about causal relationships and the fact that the relationships between SOC and bullying victimization had not been previously studied makes it advisable to conduct further research to replicate and expand these findings. Although implications for practice must accordingly be cautiously taken, results in the present study point to the potential of strengthening SOC as a useful complementary strategy for school-based health practice aimed at preventing bullying victimization and its negative consequences in health. 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Int J Nurs Pract. 2006;12(5):280-287. 21 Table 1. Bullying Victimization* Prevalence in the Study Sample Total sample Boys Girls Called mean names, made fun of, or teased in a hurtful way 9.5% 9.8% 9.3% Left out of things on purpose, excluded from group of friends, or completely ignored 7.3% 7.7% 7.0% Hit, kicked, pushed, shoved around, or locked indoors 4.3% 5.9% 2.8% Target of lies or false rumors 10.5% 10.4% 10.5% Target of sexual jokes, comments, or gestures 9.6% 11.8% 7.4% Bullied using a computer 4.0% 5.1% 3.0% Bullied using a mobile phone 3.6% 4.8% 2.5% Self-reported bullying 4.8% 6.0% 3.6% Observed bullying 21.0% 21.7% 20.3% * Victims are defined by a frequency of at least two or three episodes a month according to Solberg and Olweus criteria.25 22 Table 2. Prevalence of Different Types of Bullying Victimization* Total sample Boys Girls f % f % f % Traditional physical abuse 19 0.3% 10 0.3% 9 0.3% Traditional non-physical abuse 979 14.5% 447 13.5% 532 15.4% Traditional physical and non-physical abuse 81 1.2% 51 1.5% 30 0.9% Cyberbullying 27 0.4% 12 0.4% 15 0.4% Cyberbullying and physical abuse 7 0.1% 4 0.1% 3 0.1% Cyberbullying and non-physical abuse 114 1.7% 63 1.9% 51 1.5% Cyberbullying and combination of physical and non-physical abuse 184 2.7% 130 3.9% 54 1.6% * Victims are defined by a frequency of at least two or three episodes a month according to Solberg and Olweus criteria.25 23 Table 3. Descriptive Statistics for Type of Bullying and Means of Bullying Total sample Strong SOC Weak SOC Type of bullying N % N % N % No abuse 5349 79.8% 3010 88.5% 2225 70.9% Non-physical abuse 1093 16.3% 339 10.0% 723 23.0% Physical and non-physical abuse 265 4.0% 54 1.6% 189 6.0% Means of bullying N % N % N % No abuse 5349 79.8% 3010 88.5% 2225 70.9% Traditional bullying 1060 15.8% 344 10.1% 686 21.9% Cyberbullying 298 4.4% 49 1.4% 226 7.2% 24 Table 4. General Linear Models of Type of Bullying and Means of Bullying on Physical and Psychological Symptoms Physical symptoms SS df MS F p partial η² Corrected model 903.895 5 180.779 98.385 .000 .069 Intersection 12161.005 1 12161.005 6618.350 .000 .498 Sex 149.298 1 149.298 81.252 .000 .012 Type of bullying 212.943 2 106.471 57.945 .000 .017 Sex x Type of bullying 1.660 2 .830 .452 .637 .000 Error 12274.285 6680 1.837 Total 54224.000 6686 Corrected total 13178.179 6685 Corrected model 921.722 5 184.344 100.471 .000 .070 Intersection 14011.985 1 14011.985 7636.796 .000 .533 Sex 186.532 1 186.532 101.663 .000 .015 Means of bullying 236.615 2 118.307 64.480 .000 .019 Sex x Means of bullying 1.464 2 .732 .399 .671 .000 Error 12256.457 6680 1.835 Total 54224.000 6686 Corrected total 13178.179 6685 Psychological symptoms SS df MS F p partial η² Corrected model 1065.179 5 213.036 118.909 .000 .082 Intersection 18786.366 1 18786.366 10485.853 .000 .611 Sex 138.595 1 138.595 77.359 .000 .011 Type of bullying 542.122 2 271.061 151.296 .000 .043 Sex x Type of bullying .353 2 .177 .099 .906 .000 Error 11960.665 6676 1.792 Total 76429.000 6682 Corrected total 13025.844 6681 Corrected model 1072.288 5 214.458 119.773 .000 .082 Intersection 21890.295 1 21890.295 12225.618 .000 .647 Sex 204.182 1 204.182 114.035 .000 .017 Means of bullying 559.322 2 279.661 156.189 .000 .045 Sex x Means of bullying 8.137 2 4.069 2.272 .103 .001 Error 11953.556 6676 1.791 Total 76429.000 6682 Corrected total 13025.844 6681