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A Systematic Review of School-Based Interventions to Prevent Bullying

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A Systematic Review of School-Based Interventions to Prevent Bullying REVIEW ARTICLE A Systematic Review of School-Based Interventions to Prevent Bullying Rachel C. Vreeman, MD; Aaron E. Carroll, MD, MS Objective: To conduct a systematic review of rigor- responses to violence) and outcomes indirectly related ously evaluated school-based interventions to decrease to bullying (school achievement, perceived school bullying. safety, self-esteem, and knowledge or attitudes toward bullying). Data Sources: MEDLINE, PsycINFO, EMBASE, Edu- cational Resources Information Center, Cochrane Col- Results: Only 4 of the 10 curriculum studies showed laboration, the Physical Education Index, and Sociol- decreased bullying, but 3 of those 4 also showed no im- ogy: A SAGE Full-Text Collection were searched for the provement in some populations. Of the 10 studies evalu- terms bullying and bully. ating the whole-school approach, 7 revealed decreased bullying, with younger children having fewer positive ef- Study Selection: We found 2090 article citations and fects. Three of the social skills training studies showed reviewed the references of relevant articles. Two review- no clear bullying reduction. The mentoring study found ers critically evaluated 56 articles and found 26 studies decreased bullying for mentored children. The study of that met the inclusion criteria. increased school social workers found decreased bully- ing, truancy, theft, and drug use. Interventions: The types of interventions could be cat- egorized as curriculum (10 studies), multidisciplinary or Conclusions: Many school-based interventions di- “whole-school” interventions (10 studies), social skills rectly reduce bullying, with better results for interven- groups (4 studies), mentoring (1 study), and social worker tions that involve multiple disciplines. Curricular changes support (1 study). less often affect bullying behaviors. Outcomes indi- rectly related to bullying are not consistently improved Main Outcome Measures: Data were extracted by these interventions. regarding direct outcome measures of bullying (bully- ing, victimization, aggressive behavior, and school Arch Pediatr Adolesc Med. 2007;161:78-88 ULLYING IS A FORM OF AG- creased risk for depressive symptoms and gression in which 1 or more suicidal ideation.6,7 Students who report children repeatedly and in- victimization are 3 to 4 times more likely tentionally intimidate, ha- to report anxiety symptoms than unin- rass, or physically harm a volved children.8,9 The effects of bullying victim.1 Victims of bullying are perceived on emotional health may persist over time; B 10 by their peers as physically or psychologi- 1 study showed that children bullied re- cally weaker than the aggressor(s), and vic- peatedly through middle adolescence had tims perceive themselves as unable to re- lower self-esteem and more depressive taliate.2 Although bullying, harassment, symptoms as adults. Victims of bullying and victimization can take many forms, the are more likely to feel socially rejected or key elements of this behavior are aggres- isolated and to experience greater social sion, repetition, and the context of a re- marginalization and lower social status.11 lationship with an imbalance of power.3 Bullying impacts a child’s experience of Bullying can impact the physical, emo- school on numerous levels. Bullying cre- tional, and social health of the children ates problems with school adjustment and Author Affiliations: Children’s involved. Victims of bullying more often bonding, affecting the victims’ comple- Health Services Research, report sleep disturbances, enuresis, ab- tion of homework or desire to do well at Indiana University School of 6,12 13 Medicine (Drs Vreeman and dominal pain, headaches, and feeling sad school. In 1 study, 20% of grade- 4,5 Carroll), and The Regenstrief than children who are not bullied. Bul- school children reported being fright- Institute for Health Care lies, their victims, and those who are both ened through much of the school day. Bul- (Dr Carroll), Indianapolis, Ind. bullies and victims have significantly in- lying seems to increase school absenteeism, (REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007 WWW.ARCHPEDIATRICS.COM 78 ©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/25/2021 with victimized children becoming more school avoid- tively with the strength of treatment effects.24 Duplicate pub- ant as the victimization increases.14 Furthermore, in- lications or multiple articles that reported identical outcomes volvement in bullying affects academic performance, al- measured over the same period on the same population were though studies15-18 show mixed results regarding which excluded. children are most affected. Most bullying takes place at We extracted data from the selected articles regarding di- rect outcome measures of bullying, including bullying, victim- school, particularly at times and places where supervi- 19 ization, aggressive behavior, violence, school responses to vio- sion is minimal. Schools where adults tolerate more bul- lence, and violent injuries. Data were also extracted for outcomes 10 lying may have more severe bullying problems. thought to be indirectly related to bullying, such as school As school bullying increasingly becomes a topic of pub- achievement, perception of school safety, self-esteem, or knowl- lic concern and research efforts, a growing number of stud- edge about or attitudes toward bullying. ies examines school-based interventions targeted to re- duce bullying. Although many of these interventions have RESULTS been rigorously evaluated, the evaluations reveal mixed results.20 For example, evaluations of the Olweus Bully- ing Prevention Program, a comprehensive “whole- The systematic literature search identified 2090 articles. school” intervention on which many subsequent pro- The online search of MEDLINE yielded 353 articles, grams have been based, report reductions of 30% to 70% and the search of EMBASE yielded 269 articles, 9 of in the student reports of being bullied and bullying oth- which were not found by the MEDLINE search. The ers.2,20-22 In contrast, evaluation of a similar comprehen- search of PsycINFO yielded 897 articles, Educational Re- sive prevention program implemented in Belgium did not sources Information Center yielded 552 articles, the Physi- show significant differences in victimization or bullying cal Education Index yielded 16 articles, and Sociology: A scores among primary or secondary school students.23 Al- SAGE Full-Text Collection yielded 3 articles. An addi- 25-28 though some review articles have described several of these tional 4 potential studies were identified through interventions, to our knowledge, no systematic reviews searches of bibliographies and were also reviewed. Once of interventions to reduce bullying have been published articles that obviously did not address school-based in- in peer-reviewed literature. The objective of this study terventions were excluded, 321 relevant articles re- was to review rigorously evaluated school-based inter- mained. Reviewing the abstracts of these articles allowed ventions to reduce or prevent bullying with the goal of for the further exclusion of articles that did not address determining whether these interventions worked. school-based interventions. Fifty-six articles were then as- sessed by both of the reviewers. Articles were most com- monly excluded at this stage because they were not evalu- METHODS ations of interventions, they did not have control groups, or they did not address bullying. We searched several bibliographic databases, including MEDLINE The 26 studies that met the selection criteria varied (January 1, 1966, through August 23, 2004), PsycINFO, EMBASE, substantially in intervention type, study population, study Educational Resources Information Center, the Physical Edu- design, and outcome measures. The detailed character- cation Index, Sociology: A SAGE Full-Text Collection, and the istics of the studies are reported in Table 1. The inter- Cochrane Clinical Trials Registry (all as of August 23, 2004). ventions could be divided into 5 categories: curriculum We used the search terms bullying or bully as Medical Subject interventions, multidisciplinary or whole-school inter- Headings or keywords. We used a keyword search because it ventions, targeted social and behavioral skills groups, men- was more robust than searches using only Medical Subject Head- ings. One of us (R.C.V.) reviewed the titles of all returned ar- toring, and increased social work support. To maximize ticles and the bibliographies of all relevant review articles to clarity and clinical usefulness, we present the subse- determine which studies examined a school-based interven- quent results of the review based on the type of inter- tion to prevent or reduce bullying. Articles were immediately vention. All 26 studies investigated interventions for some excluded if they obviously did not include an intervention or group of primary school students, but the primary grade did not occur at a school. levels varied from first to eighth grade. Six stud- After articles that clearly did not meet the inclusion crite- ies22,23,30,39,41,48 included secondary school students (older ria were excluded, both of us (R.C.V. and A.E.C.), blinded to than eighth grade) in their interventions and outcomes. the journal citation and article text other than the “Methods” The selected studies reported a range of outcomes that section, independently reviewed the articles. The 2 reviewers were subsequently categorized
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